Look Out for Occult Fractures in Abused or Injured Children

Louis M. Bell, MD reviewing Wood JN et al. Pediatrics 2015 Aug.

Only half of young at-risk children are being evaluated with a skeletal survey.

In young children who suffer physical abuse, skeletal surveys have been shown to identify fractures that are not clinically suspected in 10% to 40% of children aged <2 years. Based on such findings, the American Academy of Pediatrics recommends that a skeletal survey be performed on all children aged <2 years who are suspected of having been physically abused. Despite these recommendations, the use of occult fracture examination in this high-risk group varies widely — from 55% to 93% — across U.S. hospitals. Moreover, this variability is even greater among infants aged <1 year who present with femur fractures or traumatic brain injuries that are not a result of a motor vehicle crash.

To further examine the rate of occult-fracture screening of at-risk children, investigators studied database records of 4486 children treated at 366 participating U.S. academic medical centers, community hospitals, and multihospital systems from 2009 to 2013; 97% were nonpediatric-focused centers. Two cohorts were studied: 2502 children aged <2 years diagnosed with physical abuse and 2433 infants aged <1 year with non–motor-vehicle-related femur fractures or traumatic brain injuries.

Fewer than half (48%) of children with suspected physical abuse were evaluated with a skeletal survey for occult injuries, and only 51% of infants with traumatic brain injury and 53% with femur fractures were evaluated. Black children were less likely than other racial groups to receive evaluation. Skeletal surveys for physical abuse were more likely to be performed in teaching hospitals, in the southern U.S., and in hospitals with higher volumes of abused and injured children.

Citation(s):

Wood JN et al. Evaluation for occult fractures in injured children. Pediatrics 2015 Aug; 136:232.