Bone biochemistry in children with fractures presenting with non-accidental injury.
Physical abuse
Vitamin D
Journal
Child abuse & neglect
ISSN: 1873-7757
Titre abrégé: Child Abuse Negl
Pays: England
ID NLM: 7801702
Informations de publication
Date de publication:
02 Mar 2024
02 Mar 2024
Historique:
received:
11
12
2023
revised:
01
02
2024
accepted:
07
02
2024
medline:
3
3
2024
pubmed:
3
3
2024
entrez:
3
3
2024
Statut:
aheadofprint
Résumé
In cases of fractures in children with suspicion of non-accidental injury (NAI), biochemical markers of calcium homeostasis should be performed. To describe the pattern of biochemistry in children with fractures NAI is suspected. Children ≤2 years of age who had undergone a skeletal survey as part of a child protection investigation where 1/+ fracture was identified over a ten-year period (2012-2021) at the Royal Hospital for Children, Glasgow. A retrospective review of case notes was conducted. Established criteria to classify NAI were used to distinguish confirmed NAI from non-NAI. Biochemical markers of calcium homeostasis were classified as normal or abnormal using local reference ranges. Vitamin D deficiency was classified as Vitamin D < 25 nmol/L and insufficiency as 25-50 nmol/L. One hundred and twenty-seven children were identified, of whom 107 (84 %) had bone biochemistry performed. Twenty-nine children (24 %) had injuries that were classified as confirmed NAI. In cases where NAI was confirmed either at case conference or by criminal conviction 14/29 (48 %) had one or more abnormal bone biochemical markers. None of the children displayed clinical or radiological evidence of rickets. Alkaline phosphatase (ALP) was higher in children with confirmed NAI (median 296 vs. 261, p = 0.01) but there were no other statistically significant differences in biochemical levels between those with confirmed NAI compared to those without. Those with confirmed NAI were from areas with lower SIMD score (2.0 vs. 3.0 p = 0.01) but no other differences were found between the groups. No clear predictors of NAI are demonstrated on biochemistry alone in young children with fractures.
Sections du résumé
BACKGROUND
BACKGROUND
In cases of fractures in children with suspicion of non-accidental injury (NAI), biochemical markers of calcium homeostasis should be performed.
OBJECTIVES
OBJECTIVE
To describe the pattern of biochemistry in children with fractures NAI is suspected.
PARTICIPANTS AND SETTING
METHODS
Children ≤2 years of age who had undergone a skeletal survey as part of a child protection investigation where 1/+ fracture was identified over a ten-year period (2012-2021) at the Royal Hospital for Children, Glasgow.
METHODS
METHODS
A retrospective review of case notes was conducted. Established criteria to classify NAI were used to distinguish confirmed NAI from non-NAI. Biochemical markers of calcium homeostasis were classified as normal or abnormal using local reference ranges. Vitamin D deficiency was classified as Vitamin D < 25 nmol/L and insufficiency as 25-50 nmol/L.
RESULTS
RESULTS
One hundred and twenty-seven children were identified, of whom 107 (84 %) had bone biochemistry performed. Twenty-nine children (24 %) had injuries that were classified as confirmed NAI. In cases where NAI was confirmed either at case conference or by criminal conviction 14/29 (48 %) had one or more abnormal bone biochemical markers. None of the children displayed clinical or radiological evidence of rickets. Alkaline phosphatase (ALP) was higher in children with confirmed NAI (median 296 vs. 261, p = 0.01) but there were no other statistically significant differences in biochemical levels between those with confirmed NAI compared to those without. Those with confirmed NAI were from areas with lower SIMD score (2.0 vs. 3.0 p = 0.01) but no other differences were found between the groups.
CONCLUSION
CONCLUSIONS
No clear predictors of NAI are demonstrated on biochemistry alone in young children with fractures.
Identifiants
pubmed: 38431992
pii: S0145-2134(24)00076-0
doi: 10.1016/j.chiabu.2024.106693
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
106693Informations de copyright
Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors have no conflicts of interest to disclose.