In children who are being evaluated for possible child abuse, the American Academy of Pediatrics recommends that physicians order a skeletal survey – or radiographical examination of the entire skeleton – to look for fractures that require medical treatment, as well as to document older fractures and other findings that are important to safeguard the well-being of the child.
Specific patterns of fractures can confirm a diagnosis of abuse and allow for protection of the child. In a new study, “Evaluation for Occult Fractures in Injured Children,” in the August 2015 Pediatrics (published online July 13), researchers found only about half of children with injuries suspicious of abuse received the appropriate test.
For the retrospective study, researchers examined hospital data for children under age 2 with a diagnosis of physical abuse, as well as data for infants under age 1 with a traumatic brain injury or femur fractures.
Evaluations for occult fractures – or fractures that are not apparent based on history and physical examination, but can be detected on skeletal survey – were performed in 48 percent of the children with an abuse diagnosis.
The evaluations occurred in 51 percent of infants with traumatic brain injury, and in 53 percent of infants with femur fractures. Hospitals varied substantially with regard to their rates of evaluation for occult fractures in all three groups. The study authors conclude the data highlight missed opportunities to detect abuse and protect children.
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The American Academy of Pediatrics is an organization of 64,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.
This issue of Pediatrics includes a related commentary, “Outcome Data Needed: Interpreting Variation in the Medical Evaluation of Child Physical Abuse.”