Intracranial Injury Among Children with Abuse-Related Long Bone Fractures.
abusive head trauma
head CT
intracranial injury
long bone fracture
skeletal survey
skull fracture
Journal
The Journal of emergency medicine
ISSN: 0736-4679
Titre abrégé: J Emerg Med
Pays: United States
ID NLM: 8412174
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
11
11
2019
revised:
13
05
2020
accepted:
01
06
2020
pubmed:
20
7
2020
medline:
24
6
2021
entrez:
20
7
2020
Statut:
ppublish
Résumé
Intracranial injury (ICI) from abusive head trauma is the leading cause of death among young abused children but is difficult to detect. Long bone fracture (LBF) may lead to the recognition of abuse in young abused children. This study is the first to report the incidence and features of ICI in children with abuse and LBFs. This is a retrospective study of children younger than 3 years with the diagnosis of LBF in the National Trauma Data Bank from 2009 to 2014. LBF, abuse, and clinical features were identified using International Classification of Diseases, Ninth Revision codes. Abuse-related LBF with and without ICI were compared to identify risk factors for ICI. There were 4345 encounters for abuse-related LBF in kids ages < 3 years; 970 (22%) had ICI. Infants < 1 year of age were more likely to have ICI compared with older children (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.38-2.33). After adjusting for age, fracture of the ulna, radius, tibia, or fibula were associated with greater odds of ICI (OR 3.35, 95% CI 2.81-4.00). Abuse-related LBF with additional findings of skull fracture, rib fracture, or head/neck bruising had an increased odds of ICI (OR 8.27, 95% CI 6.85-9.98; OR 2.67, 95% CI 2.28-3.14; OR 2.41, 95% CI 1.99-2.92, respectively). ICI occurred in nearly 1 in 4 children under 3 years old with abuse-related LBF. Abuse-related LBF with skull fracture, rib fracture, head/neck bruising, or patient age < 1 year should prompt consideration for ICI with head imaging.
Sections du résumé
BACKGROUND
BACKGROUND
Intracranial injury (ICI) from abusive head trauma is the leading cause of death among young abused children but is difficult to detect. Long bone fracture (LBF) may lead to the recognition of abuse in young abused children.
OBJECTIVES
OBJECTIVE
This study is the first to report the incidence and features of ICI in children with abuse and LBFs.
METHODS
METHODS
This is a retrospective study of children younger than 3 years with the diagnosis of LBF in the National Trauma Data Bank from 2009 to 2014. LBF, abuse, and clinical features were identified using International Classification of Diseases, Ninth Revision codes. Abuse-related LBF with and without ICI were compared to identify risk factors for ICI.
RESULTS
RESULTS
There were 4345 encounters for abuse-related LBF in kids ages < 3 years; 970 (22%) had ICI. Infants < 1 year of age were more likely to have ICI compared with older children (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.38-2.33). After adjusting for age, fracture of the ulna, radius, tibia, or fibula were associated with greater odds of ICI (OR 3.35, 95% CI 2.81-4.00). Abuse-related LBF with additional findings of skull fracture, rib fracture, or head/neck bruising had an increased odds of ICI (OR 8.27, 95% CI 6.85-9.98; OR 2.67, 95% CI 2.28-3.14; OR 2.41, 95% CI 1.99-2.92, respectively).
CONCLUSIONS
CONCLUSIONS
ICI occurred in nearly 1 in 4 children under 3 years old with abuse-related LBF. Abuse-related LBF with skull fracture, rib fracture, head/neck bruising, or patient age < 1 year should prompt consideration for ICI with head imaging.
Identifiants
pubmed: 32682640
pii: S0736-4679(20)30555-2
doi: 10.1016/j.jemermed.2020.06.006
pmc: PMC7364151
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
735-743Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
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