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Fracture at Certain Ages May Prompt Child Abuse Evaluation

FRIDAY, Jan. 29, 2021 -- Routine evaluation for child abuse is recommended for children aged younger than 3 years presenting with rib fractures and for children aged younger than 18 months presenting with humeral or femoral fractures, according to a review published in the January issue of Academic Emergency Medicine.

Ian C. Mitchell, M.D., from the University of Texas Health Science Center at San Antonio and Baylor College of Medicine, and colleagues conducted a systematic review to determine which children presenting with rib or long-bone fractures should undergo routine abuse evaluation based on age.

The researchers identified studies with comparable age ranges of patients and adequate evidence to meet the determination of abuse standard for pediatric patients with rib, humeral, and femoral fractures. Overall, 77 percent of children aged younger than 3 years presenting with rib fractures were abused; on exclusion of those involved in motor vehicle collisions, 96 percent were abused. Forty-eight percent of children aged younger than 18 months with humeral fractures had abuse identified. Abuse was diagnosed in 34 and 25 percent of children with femoral fractures aged younger than 12 and 18 months, respectively.

"These recommendations are intended to guide practitioners and facilities in standardizing the age at which an abuse evaluation is routinely initiated for young children presenting with rib, humeral, and/or femoral fractures who were not in an independently verified incident, regardless of clinical suspicion," the authors write.

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Posted: January 2021

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