Routine evaluation and specialty consultation recommended for young children presenting with fractures

Reviewed by Emily Henderson, B.Sc.Jan 13 2021

Among children who were not in an independently verified incident, evaluation for child abuse should be done by specialty consultation in children aged less than three-years old presenting with rib fractures and children aged less than 18-months presenting with humeral or femoral fractures. That is the conclusion of a study titled Identifying Maltreatment in Infants and Young Children Presenting with Fractures: Does Age Matter?, to be published in the January 2021 issue of Academic Emergency Medicine (AEM), a journal of the Society for Academic Emergency Medicine (SAEM).

The lead author of the study is Ian C. Mitchell, MD, a pediatric surgery specialist, Departments of Surgery, University of Texas Health Science Center at San Antonio and Baylor College of Medicine, San Antonio, TX. The findings of the study are discussed in a recent AEM podcast.

According to the study findings, 77 percent of children presenting with rib fractures aged less than three years were abused; when those involved in motor vehicle collisions were excluded, 96% were abused. Abuse was identified in 48% of children less than 18-months with humeral fractures. Among those with femoral fractures, abuse was diagnosed in 34% and 25% of children aged less than 12 and 18?months, respectively.

Commenting on the study is Mark R. Zonfrillo, MD, MSCE, associate professor of emergency medicine and pediatrics at Alpert Medical School of Brown University and Hasbro Children's Hospital:

"Undiagnosed child abuse can lead to subsequent serious injury or death, and understanding injury characteristics that can predict increased risk of an abusive injury is critical. This systematic review identified rib fractures in children younger than three years old and humeral or femoral fractures in children younger than 18 months old, and without an independently verified injury mechanism, as higher risk for abuse. For these patients, the authors recommend diagnostic evaluation and consultation for potential abuse in order to minimize morbidity and mortality from these intentional injuries."