Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers

FurAHA Study Grp; Marie-Louise H. J. Loos; Roel Bakx; J. H. Allema; Frank W. Bloemers; Jan A. ten Bosch; Michael J. R. Edwards; Jan B. F. Hulscher; Claudia M. G. Keyzer-Dekker; Egbert Krug; Victor A. de Ridder; W. Richard Spanjersberg; Arianne H. Teeuw; Hilco P. Theeuwes; Selena de Vries; Ralph de Wit; Rick R. van Rijn

doi:10.1007/s00247-022-05378-8

Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers

FurAHA Study Grp, Marie-Louise H. J. Loos^*, Roel Bakx, J. H. Allema, Frank W. Bloemers, Jan A. ten Bosch, Michael J. R. Edwards, Jan B. F. Hulscher, Claudia M. G. Keyzer-Dekker, Egbert Krug, Victor A. de Ridder, W. Richard Spanjersberg, Arianne H. Teeuw, Hilco P. Theeuwes, Selena de Vries, Ralph de Wit, Rick R. van Rijn

^*Corresponding author voor dit werk

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Background The prevalence of inflicted femur fractures in young children varies (1.5-35.2%), but these data are based on small retrospective studies with high heterogeneity. Age and mobility of the child seem to be indicators of inflicted trauma.

Objective This study describes other factors associated with inflicted and neglectful trauma that can be used to distinguish inflicted and neglectful from accidental femur fractures.

Materials and methods This retrospective study included children (0-6 years) who presented with an isolated femur fracture at 1 of the 11 level I trauma centers in the Netherlands between January 2010 and January 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect teams or the court. Cases in which conclusions were unavailable and there was no clear accidental cause were reviewed by an expert panel.

Results The study included 328 children; 295 (89.9%) cases were classified as accidental trauma. Inflicted trauma was found in 14 (4.3%), while 19 (5.8%) were cases of neglect. Indicators of inflicted trauma were age 0-5 months (29%, positive likelihood ratio [LR +] 8.35), 6-12 months (18%, LR +5.98) and 18-23 months (14%, LR +3.74). Indicators of neglect were age 6-11 months (18%, LR +4.41) and age 18-23 months (8%, LR + 1.65). There was no difference in fracture morphology among groups.

Conclusion It is unlikely that an isolated femur fracture in ambulatory children age > 24 months is caused by inflicted trauma/ neglect. Caution is advised in children younger than 24 months because that age is the main factor associated with inflicted trauma/neglect and inflicted femur fractures.

Originele taal-2	English
Pagina's (van-tot)	2359–2367
Aantal pagina's	9
Tijdschrift	Pediatric radiology
Volume	52
Vroegere onlinedatum	7-mei-2022
DOI's	https://doi.org/10.1007/s00247-022-05378-8
Status	Published - nov.-2022

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FurAHA Study Grp, Loos, M.-L. H. J., Bakx, R., Allema, J. H., Bloemers, F. W., ten Bosch, J. A., Edwards, M. J. R., Hulscher, J. B. F., Keyzer-Dekker, C. M. G., Krug, E., de Ridder, V. A., Spanjersberg, W. R., Teeuw, A. H., Theeuwes, H. P., de Vries, S., de Wit, R., & van Rijn, R. R. (2022). Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers. Pediatric radiology, 52, 2359–2367. https://doi.org/10.1007/s00247-022-05378-8

@article{316ade92b3f941fa8c9f9cc13e7b3e26,

title = "Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers",

abstract = "Background The prevalence of inflicted femur fractures in young children varies (1.5-35.2%), but these data are based on small retrospective studies with high heterogeneity. Age and mobility of the child seem to be indicators of inflicted trauma.Objective This study describes other factors associated with inflicted and neglectful trauma that can be used to distinguish inflicted and neglectful from accidental femur fractures.Materials and methods This retrospective study included children (0-6 years) who presented with an isolated femur fracture at 1 of the 11 level I trauma centers in the Netherlands between January 2010 and January 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect teams or the court. Cases in which conclusions were unavailable and there was no clear accidental cause were reviewed by an expert panel.Results The study included 328 children; 295 (89.9%) cases were classified as accidental trauma. Inflicted trauma was found in 14 (4.3%), while 19 (5.8%) were cases of neglect. Indicators of inflicted trauma were age 0-5 months (29%, positive likelihood ratio [LR +] 8.35), 6-12 months (18%, LR +5.98) and 18-23 months (14%, LR +3.74). Indicators of neglect were age 6-11 months (18%, LR +4.41) and age 18-23 months (8%, LR + 1.65). There was no difference in fracture morphology among groups.Conclusion It is unlikely that an isolated femur fracture in ambulatory children age > 24 months is caused by inflicted trauma/ neglect. Caution is advised in children younger than 24 months because that age is the main factor associated with inflicted trauma/neglect and inflicted femur fractures.",

keywords = "Child abuse, Children, Femur, Fractures, Infants, Inflicted trauma, Radiography, TIBIAL FRACTURES, ABUSE, PATTERNS, INJURY, TODDLERS, INFANTS",

author = "{FurAHA Study Grp} and Loos, {Marie-Louise H. J.} and Roel Bakx and Allema, {J. H.} and Bloemers, {Frank W.} and {ten Bosch}, {Jan A.} and Edwards, {Michael J. R.} and Hulscher, {Jan B. F.} and Keyzer-Dekker, {Claudia M. G.} and Egbert Krug and {de Ridder}, {Victor A.} and Spanjersberg, {W. Richard} and Teeuw, {Arianne H.} and Theeuwes, {Hilco P.} and {de Vries}, Selena and {de Wit}, Ralph and {van Rijn}, {Rick R.}",

year = "2022",

month = nov,

doi = "10.1007/s00247-022-05378-8",

language = "English",

volume = "52",

pages = "2359–2367",

journal = "Pediatric radiology",

issn = "0301-0449",

publisher = "Springer",

}

FurAHA Study Grp, Loos, M-LHJ, Bakx, R, Allema, JH, Bloemers, FW, ten Bosch, JA, Edwards, MJR, Hulscher, JBF, Keyzer-Dekker, CMG, Krug, E, de Ridder, VA, Spanjersberg, WR, Teeuw, AH, Theeuwes, HP, de Vries, S, de Wit, R & van Rijn, RR 2022, 'Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers', Pediatric radiology, vol. 52, blz. 2359–2367. https://doi.org/10.1007/s00247-022-05378-8

TY - JOUR

T1 - Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers

AU - FurAHA Study Grp

AU - Loos, Marie-Louise H. J.

AU - Bakx, Roel

AU - Allema, J. H.

AU - Bloemers, Frank W.

AU - ten Bosch, Jan A.

AU - Edwards, Michael J. R.

AU - Hulscher, Jan B. F.

AU - Keyzer-Dekker, Claudia M. G.

AU - Krug, Egbert

AU - de Ridder, Victor A.

AU - Spanjersberg, W. Richard

AU - Teeuw, Arianne H.

AU - Theeuwes, Hilco P.

AU - de Vries, Selena

AU - de Wit, Ralph

AU - van Rijn, Rick R.

PY - 2022/11

Y1 - 2022/11

N2 - Background The prevalence of inflicted femur fractures in young children varies (1.5-35.2%), but these data are based on small retrospective studies with high heterogeneity. Age and mobility of the child seem to be indicators of inflicted trauma.Objective This study describes other factors associated with inflicted and neglectful trauma that can be used to distinguish inflicted and neglectful from accidental femur fractures.Materials and methods This retrospective study included children (0-6 years) who presented with an isolated femur fracture at 1 of the 11 level I trauma centers in the Netherlands between January 2010 and January 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect teams or the court. Cases in which conclusions were unavailable and there was no clear accidental cause were reviewed by an expert panel.Results The study included 328 children; 295 (89.9%) cases were classified as accidental trauma. Inflicted trauma was found in 14 (4.3%), while 19 (5.8%) were cases of neglect. Indicators of inflicted trauma were age 0-5 months (29%, positive likelihood ratio [LR +] 8.35), 6-12 months (18%, LR +5.98) and 18-23 months (14%, LR +3.74). Indicators of neglect were age 6-11 months (18%, LR +4.41) and age 18-23 months (8%, LR + 1.65). There was no difference in fracture morphology among groups.Conclusion It is unlikely that an isolated femur fracture in ambulatory children age > 24 months is caused by inflicted trauma/ neglect. Caution is advised in children younger than 24 months because that age is the main factor associated with inflicted trauma/neglect and inflicted femur fractures.

AB - Background The prevalence of inflicted femur fractures in young children varies (1.5-35.2%), but these data are based on small retrospective studies with high heterogeneity. Age and mobility of the child seem to be indicators of inflicted trauma.Objective This study describes other factors associated with inflicted and neglectful trauma that can be used to distinguish inflicted and neglectful from accidental femur fractures.Materials and methods This retrospective study included children (0-6 years) who presented with an isolated femur fracture at 1 of the 11 level I trauma centers in the Netherlands between January 2010 and January 2016. Outcomes were classified based on the conclusions of the Child Abuse and Neglect teams or the court. Cases in which conclusions were unavailable and there was no clear accidental cause were reviewed by an expert panel.Results The study included 328 children; 295 (89.9%) cases were classified as accidental trauma. Inflicted trauma was found in 14 (4.3%), while 19 (5.8%) were cases of neglect. Indicators of inflicted trauma were age 0-5 months (29%, positive likelihood ratio [LR +] 8.35), 6-12 months (18%, LR +5.98) and 18-23 months (14%, LR +3.74). Indicators of neglect were age 6-11 months (18%, LR +4.41) and age 18-23 months (8%, LR + 1.65). There was no difference in fracture morphology among groups.Conclusion It is unlikely that an isolated femur fracture in ambulatory children age > 24 months is caused by inflicted trauma/ neglect. Caution is advised in children younger than 24 months because that age is the main factor associated with inflicted trauma/neglect and inflicted femur fractures.

KW - Child abuse

KW - Children

KW - Femur

KW - Fractures

KW - Infants

KW - Inflicted trauma

KW - Radiography

KW - TIBIAL FRACTURES

KW - ABUSE

KW - PATTERNS

KW - INJURY

KW - TODDLERS

KW - INFANTS

U2 - 10.1007/s00247-022-05378-8

DO - 10.1007/s00247-022-05378-8

M3 - Article

SN - 0301-0449

VL - 52

SP - 2359

EP - 2367

JO - Pediatric radiology

JF - Pediatric radiology

ER -

Prevalence of inflicted and neglectful femur shaft fractures in young children in national level I trauma centers

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