Distinguishing Abuse and AHT among Children with Long Bone Fractures in the Emergency Department
Saydi E Chahla, Alicia Zagel, Gretchen Cutler, Henry Ortega
Children's Minnesota, Minneapolis, MN
Abusive head trauma (AHT) is the leading cause of death among young abused children. AHT is difficult to unmask and no guideline exists to aid in its detection. This study is the first to identify features which may signal abuse and AHT in children with long bone fractures (LBF) who present to trauma centers.
This is a retrospective study of children under 3 years with diagnosis of LBF in the National Trauma Data Bank (NTDB) from 2009 to 2014. LBF, abuse and clinical features were identified by ICD 9 codes. Abuse related LBF (ALBF) were compared to non-abuse related LBF (nLBF) patients to identify risk factors for abuse and AHT.
There were 27,907 LBF and 4,615 ALBF in the NTDB. All LBF studied, femur, humerus, radius, ulna, tibia, and fibula, resulted in increased risk of abuse. After adjusting for fracture type, children under 1 had the highest risk of AHT and abuse compared to children 1-2 and 2-3 years old. After adjusting for age, radial and tibia fractures alone had increased risk for AHT. Children with ALBF and AHT had longer hospital stays and more ICU admissions. LBF with additional findings of retinal hemorrhage, need for supplemental O2, intubation or head/neck bruising had higher risk of abuse and AHT.
Over 1 in 6 children under 3 years old with LBF had been abused. Among ALBF, over 1 in 8 children had subdural hemorrhage. LBF with intubation, supplemental O2, retinal hemorrhage, head/neck bruising, or age under 1 should undergo head imaging to rule out AHT.
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