Prevalence of abuse among young children with femur fractures: a systematic review

BMC Pediatrics

Chris Feudtner¹  Russell Localio³  David M Rubin¹  Valerie Mondestin²  Oludolapo Fakeye²  Joanne N Wood¹ 

[1]Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia 19104, Pennsylvania

[2]Division of General Pediatrics and PolicyLab, The Children’s Hospital of Philadelphia, 3535 Market Street, Floor 15, Philadelphia PA19104, Pennsylvania

[3]Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia 19104, Pennsylvania

关键词: Trauma;    Accident;    Femur fracture;    Child maltreatment;    Child abuse;   

Others  :  1138606
DOI  :  10.1186/1471-2431-14-169

 received in 2014-01-15, accepted in 2014-06-19,  发布年份 2014

【 摘 要 】

Background

Clinical factors that affect the likelihood of abuse in children with femur fractures have not been well elucidated. Consequently, specifying which children with femur fractures warrant an abuse evaluation is difficult. Therefore the purpose of this study is to estimate the proportion of femur fractures in young children attributable to abuse and to identify demographic, injury and presentation characteristics that affect the probability that femur fractures are secondary to abuse.

Methods

We conducted a systematic review of published articles written in English between January 1990 and July 2013 on femur fracture etiology in children less than or equal to 5 years old based on searches in PubMed/MEDLINE and CINAHL databases. Data extraction was based on pre-defined data elements and included study quality indicators. A meta-analysis was not performed due to study population heterogeneity.

Results

Across the 24 studies reviewed, there were a total of 10,717 children less than or equal to 60 months old with femur fractures. Among children less than 12 months old with all types of femur fractures, investigators found abuse rates ranging from 16.7% to 35.2%. Among children 12 months old or greater with femur fractures, abuse rates were lower: from 1.5% - 6.0%. In multiple studies, age less than 12 months, non-ambulatory status, a suspicious history, and the presence of additional injuries were associated with findings of abuse. Diaphyseal fractures were associated with a lower abuse incidence in multiple studies. Fracture side and spiral fracture type, however, were not associated with abuse.

Conclusions

Studies commonly find a high proportion of abuse among children less than 12 months old with femur fractures. The reported trauma history, physical examination findings and radiologic results must be examined for characteristics that increase or decrease the likelihood of abuse determination.

【 授权许可】

   
2014 Wood et al.; licensee BioMed Central Ltd.

【 图 表 】

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