Can we increase detection? A nationwide analysis of age-related fractures in child abuse

Purpose: The purpose of this study was to stratify fractures associated with child abuse in relation to the child's age. Methods: The Kids' Inpatient Database (1997-2012) was queried for all patients (<18 years old) with a diagnosis of fracture and child abuse. The primary outcome was age-related determinants of fracture distribution. Chi-squared analysis was used for statistical analysis where appropriate, with significance set at p < 0.05. Results: More than 39,000 children were admitted for child abuse, and 26% sustained fractures. Most were infants (median age 0 year IIQR 0-11). 28% sustained multiple fractures, and 27% had skull fractures. By age, infants had the highest rate of multiple fractures (33% vs 16% 1-4 years), and the highest rate of dosed skull fractures (33% vs 21% ages 1-4), while adolescents had more facial fractures (43% vs 11% ages 9-12), all p < 0.001. Multiple rib fractures were more commonly seen in infants (28% vs 8% ages 1-4), while children 5-8 years had the highest rates of clavicular fractures (7% vs 3% in infants), all p < 0.001. Conclusion: Age-related fracture patterns exist and may be due to changing mechanism of abuse as a child grows. These age-related fracture patterns can help aid in healthcare detection of child abuse in hopes to thwart further abuse. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

This study stratified fractures associated with child abuse by the child's age and found age-related patterns in fracture distribution, suggesting a changing mechanism of abuse as a child grows. These patterns may aid in healthcare detection of child abuse to prevent further harm.