@article{ref1,
title="Identifying maltreatment in infants and young children presenting with fractures: does age matter?",
journal="Academic emergency medicine",
year="2020",
author="Mitchell, Ian C. and Norat, Bradley J. and Auerbach, Marc and Bressler, Colleen J. and Como, John and Escobar, Mauricio A. and Flynn-O'Brien, Katherine T. and Lindberg, Daniel M. and Nickoles, Todd and Rosado, Norell and Weeks, Kerri and Maguire, Sabine",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Child abuse is a significant cause of morbidity and mortality in re-verbal children who cannot explain their injuries. Fractures are among the most common injuries associated with abuse but of themselves fractures may not be recognized as abusive until a comprehensive child abuse evaluation is completed, often prompted by other signs or subjective features. We aim to determine which children presenting with rib or long bone fractures should undergo a routine abuse evaluation based on age.   METHODS: A systematic review searching Ovid, PubMed/Medline, Scopus and CINAHL from 1980-2020 was performed. An evidence-based framework was generated by a consensus panel and applied to the results of the systematic review to form recommendations. Fifteen articles were suitable for final analysis.    RESULTS: Studies with comparable age ranges of subjects and sufficient evidence to meet the determination of abuse standard for pediatric patients with rib, humeral and femoral fractures were identified. Seventy-seven 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 months and 18 months, respectively.   CONCLUSION: Among children who were not in an independently verified incident, the authors strongly recommend routine evaluation for child abuse, including specialty child abuse consultation, for: (1) children aged less than 3 years old presenting with rib fractures, and (2) children aged less than 18 months presenting with humeral or femoral fractures.<p /> <p>Language: en</p>",
language="en",
issn="1069-6563",
doi="10.1111/acem.14122",
url="http://dx.doi.org/10.1111/acem.14122"
}