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An Analysis of Child Abuse Screening Gaps in Children Less than 3 Years of Age with Fractures
Kelly S. Falcone, MS, RN, CNL, Suzanne Moody, MPA, Charles T. Mehlman, DO, MPH and Richard A. Falcone, MD, MPH, Cincinnati Children's Hospital Medical Center, Cincinnati OH

Abstract: Purpose Although both the American Academy of Pediatrics (AAP) and the American Academy of Orthopaedic Surgery (AAOS) have screening recommendations for non-accidental trauma (NAT) it is unclear how these are followed. Recently an expert panel advocated for additional screening based on specific fracture types. The purpose of this study was to evaluate the screening patterns for children under three years old with a fracture. Methods The registry at our Level I pediatric trauma center was queried for children with fractures from January through December 2014. Patients were included if they were under 2 year old and had sustained a fracture and if they were less than 3 year old with a femur fracture. Medical records review determined if children had a skeletal survey and specific fracture type. Results 281 children were identified of which 34 (12%) were screened for NAT with a skeletal survey. According to the AAOS and expert panel recommendations an additional 20 patients should have been screened. Among children <1 yo 39% were screened while between ages 1-3 yo only 3% were screened. Conclusions The current AAP recommendations state that screening for NAT should occur for children less than 2yo with suspicious injuries, leaving significant judgment to the provider. Using these recommendations few children under 2yo were screened at our center. The use of additional available guidelines suggest at least an additional 20 children should have been screened. The extremely low screening rate for children 1-3yo raises concern that there may be additional opportunities to increase screening rates to avoid missed cases of NAT.

Objective: The learner will be able to determine which fractures should be screened for NAT under the age of two.

Objective Content: The learner will be able to determine which fractures should be screened for NAT under the age of two.

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