Incidence of fractures among children with burns with concern regarding abuse.

Abstract:

OBJECTIVE:Consensus recommendations state that a radiographic skeletal survey is mandatory for all children <2 years of age with concern for physical abuse. It has been suggested that patients with burns may represent a special subgroup at lower risk for occult fractures, compared with other abused children. Our objective was to determine the prevalence of fractures in children referred for subspecialty abuse evaluations because of burns. METHODS:We performed retrospective analyses of data collected as part of the Using Liver Transaminases to Recognize Abuse (ULTRA) research network. Data were collected for all children <5 years of age who were referred to 19 child protection teams for subspecialty child abuse evaluations over 1 year (N = 1676). We compared the rate of fractures in children presenting with burns with that in other children evaluated for abuse. RESULTS:Of 97 children <24 months of age with burns, 18 (18.6%) were also found to have fractures. Among all 1203 children <24 months of age, 649 (53.9%) had fractures. Eleven children had multiple fractures, and 12 children had fractures with radiographic evidence of healing. Two children were noted to have classic metaphyseal fractures. CONCLUSION:The rate of fractures in children who present with burns and concerns regarding physical abuse is sufficient to support the recommendation for routinely performing skeletal surveys for children <2 years of age.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Degraw M,Hicks RA,Lindberg D,Using Liver Transaminases to Recognize Abuse (ULTRA) Study Investigators.

doi

10.1542/peds.2009-1478

subject

Has Abstract

pub_date

2010-02-01 00:00:00

pages

e295-9

issue

2

eissn

0031-4005

issn

1098-4275

pii

peds.2009-1478

journal_volume

125

pub_type

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