1
|
Dowlut N, Horlick S, Ather S, Gwilym S. Humeral shaft fractures: a practical guide to assessment and management. Br J Hosp Med (Lond) 2023; 84:1-10. [PMID: 37127420 DOI: 10.12968/hmed.2020.0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Fractures of the humeral shaft represent roughly 5% of all fractures. They occur in an approximate bimodal distribution, typically affecting young adults following trauma and older females after low energy falls in the presence of osteoporosis. Humeral shaft fractures are associated with pain, temporary disability and a reduced quality of life for the duration of treatment. Treatment goals are directed towards achieving and maintaining a fracture environment conducive to healing, pain relief and early restoration of function. While most humeral shaft fractures are conservatively managed, operative management is indicated in certain circumstances. This article provides an overview of these fractures, including their initial management approach and definitive treatment.
Collapse
Affiliation(s)
- Naeem Dowlut
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Serena Horlick
- Department of Trauma and Orthopaedics, Kingston Hospital, Kingston Hospital NHS Foundation Trust, Kingston, UK
| | - Sarim Ather
- Department of Radiology, John Radcliffe Hospital, Oxford, UK
| | - Steve Gwilym
- Nuffield Department of Orthopaedics and Rheumatology (NDORMS), University of Oxford, Oxford, UK
| |
Collapse
|
2
|
Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
Collapse
Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| |
Collapse
|
3
|
Pilla NI, Nasreddine A, Christie KJ, Hennrikus WL. Rate of orthopedic resident and medical student recognition of nonaccidental trauma: a pilot study. J Pediatr Orthop B 2022; 31:407-413. [PMID: 34985011 DOI: 10.1097/bpb.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the efficacy and accuracy of mandated reporters to identify child abuse in children presenting with fractures. An Institutional Review Board approved survey-based study between January 2017 and December 2017 was conducted at a tertiary care academic medical center. 10 cases were combined to create one survey. Each case had information on presentation history, radiographic data, and social history. This study assesses the ability of 13 orthopedic residents and 11 medical students to diagnose child abuse. Participants had the option to explain their reasoning for a given case. To evaluate decision-making reasoning, we split responses into three cohorts, encompassing objective evidence, subjective evidence, or social evidence. Twenty-four participants completed the survey; 203 out of 240 (85%) included the rationale for the diagnosis of child abuse. The observed diagnostic odds ratio was 0.83 for medical students, 0.93 for junior residents, and 0.96 for senior residents. There was no statistically significant difference in diagnosing child abuse between a participant's level of experience, age, or whether participants had their own children. Participants who used more than one source of evidence were significantly more likely to make the correct diagnosis (P = 0.013). Participant decisions were no more accurate than a coin toss. The use of several data sources led to increased diagnostic accuracy. There is low accuracy in correctly diagnosing child abuse in our cohort of mandated reporters. Participants who highlighted using several sources of evidence were more likely to diagnose child abuse accurately.
Collapse
Affiliation(s)
- Nicholas I Pilla
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | | | | |
Collapse
|
4
|
Jin YT, Chen CM, Huang YC, Chung CH, Sun CA, Huang SH, Chien WC, Wu GJ. Segregating Suspected Child Maltreatment from Non-Child Maltreatment Injuries: A Population-Based Case-Control Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084591. [PMID: 35457455 PMCID: PMC9026454 DOI: 10.3390/ijerph19084591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022]
Abstract
Objective: To identify the differential patient characteristics, injury types, and treatment outcomes between hospitalized child abuse and non-child abuse injuries in Taiwan. Methods: Using the data from the National Health Insurance Research Database, we selected a total of 1525 patients under the age of 18 that were diagnosed with child abuse, as well as an additional 6100 patients as a comparison group. Chi-square test, Fisher exact test, and independent samples t-test were used to compare the differences between the abused children and the non-abuse-related injured children. The multivariate conditional logistic regression was performed to measure the risk factor of child maltreatment in injured children. Results: Intracranial injury was more frequent in the child abuse group than it was in the non-child abuse group (35.0% vs. 8.2%; p < 0.001). Children in the child abuse group tended to stay longer in the hospital and incur higher medical expenses (8.91 days vs. 4.41 days and USD 2564 vs. USD 880, respectively). In multivariate analysis, the Adjusted Odds Ratio (Adjusted OR) of abuse resulting in an injury for children in low-income families is 1.965 times higher than those in non-low-income families (p < 0.001). Children living in high urbanization areas had a significantly higher probability of being abused than those living in low urbanization areas (p < 0.001). Conclusion: Children under the age of 1 who were hospitalized with severe intracranial injuries are highly at risk for child maltreatment. Moreover, numerous high-risk environmental factors were observed in child abuse cases, including living in urban areas, families with low income, and seasonality, as child maltreatment cases occur more frequently in autumn.
Collapse
Affiliation(s)
- Yo-Ting Jin
- Department of Nursing, Fu-Jen Catholic University, New Taipei City 242062, Taiwan; (Y.-T.J.); (C.-M.C.)
- School of Nursing, National Taipei University of Nursing & Health Sciences, Taipei 11219, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chin-Mi Chen
- Department of Nursing, Fu-Jen Catholic University, New Taipei City 242062, Taiwan; (Y.-T.J.); (C.-M.C.)
| | - Yao-Ching Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology (Taipei Tech), Taipei 10608, Taiwan;
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-H.C.); (S.-H.H.)
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-H.C.); (S.-H.H.)
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei 11490, Taiwan
| | - Chien-An Sun
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan;
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan
| | - Shi-Hao Huang
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-H.C.); (S.-H.H.)
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-H.C.); (S.-H.H.)
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei 11490, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: (W.-C.C.); (G.-J.W.)
| | - Gwo-Jang Wu
- Department of Nursing, Fu-Jen Catholic University, New Taipei City 242062, Taiwan; (Y.-T.J.); (C.-M.C.)
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-H.C.); (S.-H.H.)
- Obstetrics and Gynecology Department, Tri-Service General Hospital, Taipei 11490, Taiwan
- Correspondence: (W.-C.C.); (G.-J.W.)
| |
Collapse
|
5
|
Kovler ML, Ziegfeld S, Ryan LM, Goldstein MA, Gardner R, Garcia AV, Nasr IW. Increased proportion of physical child abuse injuries at a level I pediatric trauma center during the Covid-19 pandemic. CHILD ABUSE & NEGLECT 2021; 116:104756. [PMID: 33004213 PMCID: PMC7518108 DOI: 10.1016/j.chiabu.2020.104756] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The Covid-19 pandemic has forced mass closures of childcare facilities and schools. While these measures are necessary to slow virus transmission, little is known regarding the secondary health consequences of social distancing. The purpose of this study is to assess the proportion of injuries secondary to physical child abuse (PCA) at a level I pediatric trauma center during the Covid-19 pandemic. METHODS A retrospective review of patients at our center was conducted to identify injuries caused by PCA in the month following the statewide closure of childcare facilities in Maryland. The proportion of PCA patients treated during the Covid-19 era were compared to the corresponding period in the preceding two years by Fisher's exact test. Demographics, injury profiles, and outcomes were described for each period. RESULTS Eight patients with PCA injuries were treated during the Covid-19 period (13 % of total trauma patients), compared to four in 2019 (4 %, p < 0.05) and three in 2018 (3 %, p < 0.05). The median age of patients in the Covid-19 period was 11.5 months (IQR 6.8-24.5). Most patients were black (75 %) with public health insurance (75 %). All injuries were caused by blunt trauma, resulting in scalp/face contusions (63 %), skull fractures (50 %), intracranial hemorrhage (38 %), and long bone fractures (25 %). CONCLUSIONS There was an increase in the proportion of traumatic injuries caused by physical child abuse at our center during the Covid-19 pandemic. Strategies to mitigate this secondary effect of social distancing should be thoughtfully implemented.
Collapse
Affiliation(s)
- Mark L Kovler
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Susan Ziegfeld
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Leticia M Ryan
- Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mitchell A Goldstein
- Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rebecca Gardner
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alejandro V Garcia
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Isam W Nasr
- Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
6
|
Lyme Disease Misinterpreted as Child Abuse. Case Rep Orthop 2021; 2021:6665935. [PMID: 33628554 PMCID: PMC7880705 DOI: 10.1155/2021/6665935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Child abuse is one of the most common causes for child fatality in the United States. Inaccurate reporting of child abuse combined with scarcity of resources for child abuse evaluations can lead to unintended consequences for children and their families. The differential diagnosis of child abuse is varied. To our knowledge, there are no reports in the literature on Lyme disease mimicking child abuse. The current study presents the case of a child from an endemic area for Lyme disease presenting with skin bruising, fracture, and swollen knee. The child was reported for child abuse by the pediatrician and then referred to the orthopaedic surgeon for fracture care.
Collapse
|
7
|
Yilmaz G, Alemdar DK. Evaluation of Pediatric Forensic Cases Admitted to the Emergency Department in Turkey: A Retrospective Analysis. JOURNAL OF FORENSIC NURSING 2021; 17:E1-E8. [PMID: 33350664 DOI: 10.1097/jfn.0000000000000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM The aim of this study was to determine retrospectively the demographic characteristics of forensic cases aged 0-18 years who were admitted to the emergency department. METHOD A total of 14,352 pediatric forensic cases aged 0-18 years, who were admitted to the emergency department of a hospital, were analyzed retrospectively in terms of the date of presentation, age, gender, and type of case. RESULTS Among the pediatric cases presenting to the emergency department, 56% were due to falling, 19% were due to burns, 8.5% were due to poisoning, 7.4% were due to animal bites, 5.3% were due to traffic accidents, 3.4% were due to battery, and 0.4% were due to other phenomena (electric shock and sexual abuse). Examination of the distribution of cases in terms of age showed that falling (16.4%), burns (25.7%), and poisoning (28%) were more frequent in boys in the age group of 15-18 months and in girls in the age group of 0-12 months. Presenting to the emergency department because of sexual abuse was observed to be more frequent in girls in the age groups of 10-14 years (40%) and 15-18 years (26.7%). CONCLUSION The high rates of falling, burns, and poisoning cases among children observed in this study suggest that child neglect and abuse were high and reveal the necessity of the presence of forensic nurses in the emergency departments.
Collapse
Affiliation(s)
- Gamze Yilmaz
- Author Affiliations:Ağri I˙brahim Çeçen University, School of Health, Ağri, Turkey
| | - Dilek Küçük Alemdar
- Ordu University Health Science Faculty, Department of Pediatric Nursing, Ordu, Turkey
| |
Collapse
|
8
|
Chang YT, Chang HY, Chen LW, Lu TH, Tsai HJ, Chen YW, Chang YC, Feng JY. Incidence and characteristics of paediatric abusive head trauma in Taiwan, 2006-2015: a nationwide population-based study. Inj Prev 2020; 27:356-362. [PMID: 32788223 DOI: 10.1136/injuryprev-2020-043805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the incidence rate and characteristics of paediatric abusive head trauma (PAHT) among children under age 5 years in Taiwan. METHODS The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was used to identify broad and narrow definitions of children aged under 5 years with PAHT from 2006 to 2015 in Taiwan using a representative national insurance research database. Medical resource utilisation was also analysed. Incidence rates per 100 000 person-years were calculated and presented with 95% CI. Joinpoint regression analysis was used to detect the changes in trends and calculate the annual percentage change in PAHT incidence over time. RESULTS From 2006 to 2015, 479 (narrow definition) and 538 (broad definition) PAHT cases were identified. Incidence rates of PAHT by narrow and broad definitions among children under 1 year of age (18.7/100 000 and 20.0/100 000) were nearly 10-fold or 20-fold higher than for children aged 1-2 (1.7/100 000 and 2.1/100 000) and 3-5 (0.9/100 000 and 1.2/100 000) years. The PAHT incidence significantly increased since 2012, with trends varying by age and gender. Our results suggest that over 40% of the children with PAHT experienced serious injury and nearly 13% were fatal cases. For 87% (n=57) of fatal cases, this was their first ever hospitalisation. The number of fatal cases among infants was fourfold higher than that of children aged 1-5 years. CONCLUSIONS This study provides a robust national estimate of PAHT and identifies infants as the most vulnerable group for PAHT in Taiwan. Education to enhance healthcare profession's sensitivity and competence for the early identification and diagnosis of PAHT is critical.
Collapse
Affiliation(s)
- Yi-Ting Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Yi Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, National Cheng Kung University, Tainan, Taiwan
| | - Hui-Ju Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yi-Wen Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chun Chang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Ying Feng
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan .,Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
9
|
Kennedy JM, Lazoritz S, Palusci VJ. Risk Factors for Child Maltreatment Fatalities in a National Pediatric Inpatient Database. Hosp Pediatr 2020; 10:230-237. [PMID: 32054640 PMCID: PMC7041552 DOI: 10.1542/hpeds.2019-0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Child maltreatment (CM) is recognized as a major public health concern, and an important number of children suffer injuries related to abuse and neglect that result in death. We sought to identify risk factors for CM fatalities among hospitalized children that can provide clinicians with information to recognize at-risk children and reduce further death. METHODS In this study, we included cases from the 2012 Kids' Inpatient Database with diagnosis codes related to CM who were <5 years of age and were not transferred to another facility. Potential demographic and clinical risk factors were identified and compared to child fatality in the hospital by using bivariate and multivariate analyses. To assess how cases coded specifically for maltreatment differed from similar cases that only suggested maltreatment, a reduced-model multivariable logistic regression for fatality was created. RESULTS We found 10 825 children <5 years who had inpatient diagnoses coded in their medical record for CM. Most demographic variables (age, race, and sex) were not significantly associated with fatality, whereas clinical variables (transferring in, drowning, ingestions, and burns) were significantly associated with fatality. There were regional differences on the basis of hospital location as well as significantly more chronic conditions, procedure charges, and longer lengths of stay among children who died. Controlling for significant risk factors, those with diagnoses specific for physical abuse had ∼3 times the odds of dying (odds ratio = 2.797; 95% confidence interval: 1.941-4.031). CONCLUSIONS In this study, although infancy and decreased income were associated with increased risk for fatality, more important factors were the types of injuries the child endured and whether the inpatient clinician had identified specific injuries indicating physical abuse.
Collapse
Affiliation(s)
- Juliana M Kennedy
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York; and
| | | | - Vincent J Palusci
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York; and
| |
Collapse
|
10
|
Predictors for Nonaccidental Trauma in a Child With a Fracture-A National Inpatient Database Study. J Am Acad Orthop Surg 2020; 28:e164-e171. [PMID: 31192884 DOI: 10.5435/jaaos-d-18-00502] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite heightened awareness and multidisciplinary efforts, a predictive model to help the clinician quantify the likelihood of nonaccidental trauma (NAT) in a child presenting with a fracture does not exist. The purpose of this study was to develop an evidence-based likelihood of NAT in a child presenting with a fracture. METHODS Using the 2012 Kids' Inpatient Database, we identified all available pediatric inpatients admitted with an extremity or spine fracture. Children with a fracture were subcategorized based on the diagnosis of NAT. Multivariate analysis using multiple logistic regression was used to generate odds ratios and create a predictive model for the probability of NAT in a child with a fracture. RESULTS Of the 57,183 pediatric fracture cases, 881 (1.54%) had a concurrent diagnosis of NAT. Of these children, those presenting with multiple fractures had the highest rate of NAT (2.8%). The overall mortality rate in patients presenting with fractures and abuse was 1.8%, which was twice as high as patients without abuse (odds ratio [OR] = 2.0). Based on multivariate analysis, younger age (OR = 0.5), black race (OR = 1.7), intracranial injury (OR = 3.7), concomitant rib fracture (OR = 7.2), and burns (OR = 8.3) were positive predictors of NAT in a child with a fracture. A weighted equation using regression coefficients was generated and plotted on a receiver operative characteristic curve, demonstrating excellent correlation and probability of NAT (area under curve = 0.962). (Equation - ln (P/(1 - P)) = -1.79 - 0.65 (age in years) + 0.51 (black race) + 1.97 (rib fracture) + 1.31 (intracranial injury) + 2.12 (burn)). CONCLUSION Using a large, national inpatient database, we identified an overall prevalence of 1.54% of NAT in children admitted to the hospital with a fracture. Based on five independent predictors of NAT, we generated an estimated probability chart that can be used in the clinical workup of a child with a fracture and possible NAT. This evidence-based algorithm needs to be validated in clinical practice. LEVEL OF EVIDENCE Prognostic study, Level III (case-control study).
Collapse
|
11
|
Zins ZP, Wheeler KK, Brink F, Armstrong M, Shi J, Groner JI, Xiang H. Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014. CHILD ABUSE & NEGLECT 2019; 98:104179. [PMID: 31704543 DOI: 10.1016/j.chiabu.2019.104179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/30/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine if US child physical abuse and neglect injury rates changed from 2006 to 2014, whether definitive diagnoses of physical abuse and neglect were used more often over time, and what patient factors influenced definitive physical maltreatment diagnoses. METHODS Nationally estimated rates of definitive and suggestive physical abuse and neglect injuries for children <10 years were generated using the Nationwide Emergency Department Sample, the National Inpatient Sample, and census estimates. Trends over time were evaluated, including the trend in the proportion of definitive diagnoses to all diagnoses (definitive plus suggestive). Logistic regression was used to evaluate whether patient characteristics and hospital patient volumes were associated with definitive versus suggestive diagnoses. RESULTS The population rates of child physical maltreatment medically treated injuries were unchanged from 2006 to 2014; the trends were not statistically significant for ED or hospitalized patients. Over time, physician definitive diagnoses as a proportion of all physical maltreatment diagnoses (definitive plus suggestive) increased in admitted children from 17.6% in 2006 to 22.0% in 2014 (p = 0.02). Older age, white race, lower income by zip code, and public insurance as well as larger patient volumes increased the odds of definitive rather than suggestive diagnoses of physical abuse and neglect injuries. CONCLUSIONS Definitive diagnoses of physical abuse and neglect increased over the study period and were associated with hospital volume and patient characteristics which may reflect provider experience and possible bias. The use of electronic medical records may have influenced the coding of definitive diagnoses.
Collapse
Affiliation(s)
- Zachary P Zins
- The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, USA.
| | - Krista K Wheeler
- Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Farah Brink
- The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, USA; The Center for Family Safety and Healing, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Megan Armstrong
- Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Junxin Shi
- Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Jonathan I Groner
- The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Trauma Program, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Henry Xiang
- The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH 43210, USA; Center for Pediatric Trauma Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| |
Collapse
|
12
|
Ramgopal S, Shaffiey SA, Conti KA. Pediatric sternal fractures from a Level 1 trauma center. J Pediatr Surg 2019; 54:1628-1631. [PMID: 30274707 DOI: 10.1016/j.jpedsurg.2018.08.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/26/2018] [Accepted: 08/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Sternal fractures are rare in children. The purpose of this series is to document traumatic findings in pediatric patients with sternal fractures at a Level 1 trauma center. STUDY DESIGN We reviewed the charts of patients with radiologically confirmed sternal fractures from a trauma database at a pediatric Level 1 trauma center between January 1, 2000 and December 31, 2015. We report mechanisms of injury, associated injuries, complications, and outcomes associated with sternal fractures. RESULTS Over the 16-year period, 19/25,781 (0.07%) admitted patients had radiologically confirmed sternal fractures. 15/19 (78.9%) patients were male. The median age was 14 years, with interquartile range 10-16 years. 7/19, (36.8%) were sustained owing to motor vehicle accidents. Associated injuries included substernal hematoma (n = 6), pulmonary contusion (n = 4), vertebral injury (n = 2), rib fracture (n = 4), intraabdominal injury (n = 3), pneumothorax (n = 3), long bone injury (n = 3) traumatic brain injury (n = 2), hemothorax (n = 2), pneumomediastinum (n = 2) and cardiac contusion (n = 1). CONCLUSIONS In this series, pediatric sternal fractures were caused by high velocity mechanisms and had significant comorbidity. While patients with isolated sternal fractures may be candidates for emergency department discharge, a thorough evaluation should be performed in children with sternal fractures to identify concurrent injuries. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Sriram Ramgopal
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine; Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.
| | - Shahab A Shaffiey
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, University of Pittsburgh School of Medicine; Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Kavitha A Conti
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine; Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
13
|
Sivasundaram L, Trivedi NN, Gatta J, Ning AY, Kim CY, Mistovich RJ. Demographics and Risk Factors for Non-Accidental Orthopedic Trauma. Clin Pediatr (Phila) 2019; 58:618-626. [PMID: 30773927 DOI: 10.1177/0009922819829045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Childhood non-accidental trauma (NAT) is the second most common cause of death in children. Despite its prevalence, NAT is frequently unreported due to provider misdiagnosis or unawareness. The purpose of this study was to determine current risk factors and injury patterns associated with NAT. A retrospective review of the Kids' Inpatient Database was performed for the years 2009 and 2012. Univariate and multivariate analyses were used to determine the statistically significant risk factors for NAT. In 2009 and 2012, 174 442 children were hospitalized for fractures. Of these, 2.07% (3614) were due to NAT. Lower extremity (femur, tibia/fibula, foot), hand/carpus, clavicle, pelvis, and spine fractures were more likely to result from NAT; tibia/fibula fractures were most predictive of NAT. Children with anxiety, attention-deficit, conduct, developmental, and mood disorders were more likely to experience NAT. Those with cerebral palsy and autism were not at an increased risk for NAT.
Collapse
Affiliation(s)
- Lakshmanan Sivasundaram
- 1 Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,2 Case Western Reserve University, Cleveland, OH, USA
| | - Nikunj N Trivedi
- 1 Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,2 Case Western Reserve University, Cleveland, OH, USA
| | - Julian Gatta
- 1 Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,2 Case Western Reserve University, Cleveland, OH, USA
| | - Anne Y Ning
- 1 Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,2 Case Western Reserve University, Cleveland, OH, USA
| | - Chang-Yeon Kim
- 1 Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,2 Case Western Reserve University, Cleveland, OH, USA
| | - R Justin Mistovich
- 1 Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,2 Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
14
|
Bright MA, Lynne SD, Masyn KE, Waldman MR, Graber J, Alexander R. Association of Friday School Report Card Release With Saturday Incidence Rates of Agency-Verified Physical Child Abuse. JAMA Pediatr 2019; 173:176-182. [PMID: 30556830 PMCID: PMC6439612 DOI: 10.1001/jamapediatrics.2018.4346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/07/2018] [Indexed: 11/14/2022]
Abstract
Importance Corporal punishment is a leading risk factor for physical abuse. Strong anecdotal evidence from physicians and other professionals working in child protection suggest that punishment-initiated physical abuse for school-aged children increases after release of report cards. However, no empirical examination of this association has occurred. Objective To examine the temporal association between school report card release and incidence rates (IRs) of physical abuse. Design, Setting, and Participants This retrospective study reviewed calls to a state child abuse hotline and school report card release dates across a single academic year in Florida. Data were collected in a 265-day window from September 8, 2015, to May 30, 2016, in the 64 of 67 Florida counties with report card release dates available (16 960 days). Participants included all children aged 5 to 11 years for whom calls were made. A total of 1943 verified cases of physical abuse were reported in the study period in the 64 counties. Data were analyzed from October 2017 through May 2018. Exposures School report cards release across a single academic year, measured daily by county. Main Outcomes and Measures Daily counts of calls to a child abuse hotline that later resulted in agency-verified incidents of child physical abuse across a single academic year by county. Results During the academic year, 167 906 calls came in to the child abuse hotline for children aged 5 to 11 years; 17.8% (n = 29 887) of these calls were suspected incidents of physical abuse, and 2017 (6.7%) of these suspected incidents were later verified as cases of physical abuse before excluding the 3 counties with no release dates available. Among the 1943 cases included in the analysis (58.9% males [n = 1145]; mean [SD] age, 7.69 [1.92] years), calls resulting in verified reports of child physical abuse occurred at a higher rate on Saturdays after a Friday report card release compared with Saturdays that do not follow a Friday report card release (IR ratio, 3.75; 95% CI, 1.21-11.63; P = .02). No significant association of report card release with IRs was found for any other days of the week. Conclusion and Relevance This association of school report card release and physical abuse appears to illustrate a unique systems-based opportunity for prevention.
Collapse
Affiliation(s)
- Melissa A. Bright
- Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, Gainesville
| | - Sarah D. Lynne
- Department of Family, Youth, and Community Sciences, University of Florida, Gainesville
| | - Katherine E. Masyn
- Population Health Sciences, School of Public Health, Georgia State University, Atlanta
| | - Marcus R. Waldman
- Quantitative Policy Analysis in Education, Harvard University, Cambridge, Massachusetts
| | - Julia Graber
- Department of Psychology, University of Florida, Gainesville
| | - Randell Alexander
- Division of Child Protection and Forensic Pediatrics, Department of Pediatrics, University of Florida, Jacksonville
| |
Collapse
|
15
|
Wood JN, Henry MK, Berger RP, Lindberg DM, Anderst JD, Song L, Localio R, Feudtner C. Use and Utility of Skeletal Surveys to Evaluate for Occult Fractures in Young Injured Children. Acad Pediatr 2019; 19:428-437. [PMID: 30121318 PMCID: PMC6377846 DOI: 10.1016/j.acap.2018.08.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To describe the percentage and characteristics of children aged <24 months with non-motor vehicle crash (MVC)-related injuries who undergo a skeletal survey and have occult fractures. METHODS We performed a retrospective chart review of a stratified, systematic random sample of 1769 children aged<24 months with non-MVC-related bruises, burns, fractures, abdominal injuries, and head injuries at 4 children's hospitals between 2008 and 2012. Sampling weights were assigned to each child to allow for representative hospital-level population estimates. Logistic regression models were used to test for associations between patient characteristics with outcomes of skeletal survey completion and occult fracture identification. RESULTS Skeletal surveys were performed in 46.3% of children aged 0 to 5 months, in 21.1% of those aged 6 to 11 months, in 8.0% of those aged 12 to 17 months, and in 6.2% of those aged 18 to 24 months. Skeletal surveys were performed most frequently in children with traumatic brain injuries (64.7%) and rib fractures (100%) and least frequently in those with burns (2.1%) and minor head injuries (4.4%). In adjusted analyses, older age, private insurance, and reported history of accidental trauma were associated with decreased skeletal survey use (P ≤ .001 for all). The prevalence of occult fractures on skeletal surveys ranged from 24.6% in children aged 0 to 5months to 3.6% in those aged 18 to 24 months, and varied within age categories based on the presenting injury (P < .001). CONCLUSIONS The high rate of occult fractures in infants aged 0 to 5 months underscores the importance of increasing the use of skeletal surveys in this population. Further research is needed to identify the injury characteristics of older infants and toddlers most at risk for occult fractures.
Collapse
Affiliation(s)
- Joanne N Wood
- Center for Pediatric Clinical Effectiveness (JN Wood, MK Henry, L, Song, and C Feudtner); PolicyLab (JN Wood and L Song), Division of General Pediatrics, Roberts Center for Pediatric Research, Children's Hospital of Philadelphia; Department of Pediatrics (JN Wood, MK Henry, and C Feudtner), Perelman School of Medicine at the University of Pennsylvania.
| | - M. Katherine Henry
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Division of General Pediatrics, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA 19146,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104
| | - Rachel P. Berger
- Department of Pediatrics, Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Safar Center for Resuscitation Research, University of Pittsburgh, 4401 Penn Ave, 2nd Floor, Pittsburgh, PA 15224
| | - Daniel M. Lindberg
- Department of Emergency Medicine and The Kempe Center for the Prevention and Treatment of Child Abuse & Neglect. University of Colorado School of Medicine. 12401 E. 17th Ave. Aurora, CO 80238
| | - James D. Anderst
- Department of Pediatrics, Division of Child Abuse and Neglect, University of Missouri Kansas City School of Medicine and Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 6410
| | - Lihai Song
- PolicyLab, Children’s Hospital of Philadelphia, Division of General Pediatrics, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA 19146
| | - Russell Localio
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, 204 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104
| | - Chris Feudtner
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Division of General Pediatrics, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA 19146,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104
| |
Collapse
|
16
|
Jawadi AH, Benmeakel M, Alkathiri M, Almuneef MA, Philip W, Almuntaser M. Characteristics of Nonaccidental Fractures in Abused Children in Riyadh, Saudi Arabia. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2018; 7:9-15. [PMID: 30787851 PMCID: PMC6381845 DOI: 10.4103/sjmms.sjmms_12_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background: Child abuse is a major problem globally. Nonaccidental fractures are the second most common injury among physically abused children; however, there is a lack of studies describing the characteristics of nonaccidental fractures in Saudi Arabia. Objectives: The objective of this study was to determine the characteristics of nonaccidental fractures among abused children in Riyadh, Saudi Arabia, using radiography. Materials and Methods: This retrospective study analyzed the data and radiographs of all nonaccidental fracture cases in children (aged ≤14 years) registered in the National Family Safety Program Registry at King Abdulaziz Medical City, Riyadh, between 2009 and 2015. Results: A total of 1512 cases of child abuse were found in the National Family Safety Program Registry database from Riyadh city. From these, 103 fractures were identified; however, radiographs were available for only 70 fractures from 56 children. Of these, 33 (59%) were boys, and 25 (45%) were aged 1–5 years. In terms of the type of abuse, neglect was more common than physical abuse (52% vs. 45%). History of injury was identified in 75% (42) of the cases, of which fall accounted for about 55% (23). Nearly 79% of children presented with a single bone fracture, while 21% had multiple bone fractures. The most common sites of fractures were skull (40%), upper limbs (31%) and lower limbs (29%). The most common fracture pattern was transverse fractures (48%), and it was mainly diagnosed in skull fractures (51%). Conclusions: This study found that in Riyadh, Saudi Arabia, neglect is the most common cause of nonaccidental fractures, abusive head trauma is the most commonly associated injury and transverse fracture is the primary pattern of fracture in abused children. Notably, as most children experienced a single-bone fracture, the authors recommend clinicians to lower their threshold of considering abuse even in cases with an isolated fracture.
Collapse
Affiliation(s)
- Ayman Hussain Jawadi
- Division of Orthopedic Surgery, King Abdulaziz Medical City - Ministry of National Guard, Riyadh, Saudi Arabia
| | - Mohammed Benmeakel
- Division of Orthopedic Surgery, King Abdulaziz Medical City - Ministry of National Guard, Riyadh, Saudi Arabia
| | - Moath Alkathiri
- Division of Family and Community Medicine, King Abdulaziz Medical City - Ministry of National Guard, Riyadh, Saudi Arabia
| | - Maha A Almuneef
- Division of Pediatric Infectious Diseases, King Abdullah Specialized Children Hospital, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,National Family Safety Program, Ministry of National Guard, Riyadh, Saudi Arabia
| | - Winnie Philip
- Research Unit, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Manal Almuntaser
- Division of Suspected Child Abuse and Neglect Team, National Family Safety Program, Ministry of National Guard, Riyadh, Saudi Arabia
| |
Collapse
|
17
|
Leaman L, Hennrikus W, Nasreddine AY. An Evaluation of Seasonal Variation of Nonaccidental Fractures in Children Less Than 1 Year of Age. Clin Pediatr (Phila) 2017; 56:1345-1349. [PMID: 28135879 DOI: 10.1177/0009922816687324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to identify seasonal variation in nonaccidental injury (NAI) in children <1 year of age. Fifty consecutive patients age ≤12 months with a fracture were identified between January 2010 and June 2012. Patients' records were reviewed for demographic, clinical, and radiographic data. Zip code was used to collect socioeconomic data. Out of 50 patients included in the study, fractures in 16 (32%) patients were reported for abuse. NAI was reported in 2/13 (15%) fracture cases presenting in the spring, 5/6 (83%) in summer, 6/15 (40%) in autumn, and 3/14 (21%) in winter. The ratio of NAI to accidental injury was highest in the summer. Presentation in summer was associated with NAI ( P < .001). In addition, NAI was associated with parental unemployment, single parents, and lower socioeconomic status ( P < .001). Seasonal variation occurred, and the most common season for NAI was the summer; also, NAI in children <1 year of age was associated with parental unemployment, single parent, and poverty.
Collapse
Affiliation(s)
- Laura Leaman
- 1 Penn State College of Medicine, Hershey, PA, USA.,2 Penn State Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | - William Hennrikus
- 1 Penn State College of Medicine, Hershey, PA, USA.,2 Penn State Hershey Medical Center, Bone and Joint Institute, Hershey, PA, USA
| | | |
Collapse
|
18
|
Miyamoto S, Romano PS, Putnam-Hornstein E, Thurston H, Dharmar M, Joseph JG. Risk factors for fatal and non-fatal child maltreatment in families previously investigated by CPS: A case-control study. CHILD ABUSE & NEGLECT 2017; 63:222-232. [PMID: 27881240 DOI: 10.1016/j.chiabu.2016.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/07/2016] [Indexed: 06/06/2023]
Abstract
The objective of this study was to identify individual, family and caregiver risk factors for serious child maltreatment, resulting in hospitalization or death, among children and families investigated by Child Protective Services (CPS). We conducted a matched case-control study of 234 children who sustained fatal or serious nonfatal maltreatment due to physical abuse or neglect and whose mother was named in a CPS investigation between 1999 and 2013. A total of 702 children and their caregivers were included in the study with 234 cases matched 2:1,resulting in 468 controls. Data on potential risk factors were abstracted from three county administrative databases. Differences between cases and controls were calculated and multivariable conditional logistic regression was used to estimate risk models. Variables associated with increased risk for serious maltreatment included male child gender,younger caregivers, three or more children under the age of 5 living in the home, families in which a biologic child was not living with either parent, and scoring moderate or high on the Structured Decision Making Risk Tool®. Caregiver involvement in intimate partner violence (IPV) and child enrollment in public health insurance appears to mitigate the risk of serious maltreatment.
Collapse
Affiliation(s)
| | - Patrick S Romano
- Department of Pediatrics, UC Davis, Sacramento, CA, USA; Center for Healthcare Policy and Research, UC Davis, CA, USA.
| | - Emily Putnam-Hornstein
- Children's Data Network, USC School of Social Work, Los Angeles, CA, USA; California Child Welfare Indicators Project, UC Berkeley, School of Social Welfare, Berkeley, CA, USA.
| | - Holly Thurston
- Betty Irene Moore School of Nursing, UC Davis, Sacramento, CA, USA; Department of Health and Human Services, Sacramento County, CA, USA.
| | - Madan Dharmar
- Betty Irene Moore School of Nursing, UC Davis, Sacramento, CA, USA; Department of Pediatrics, UC Davis, Sacramento, CA, USA; Center for Healthcare Policy and Research, UC Davis, CA, USA; Center for Health and Technology, UC Davis, Sacramento, CA, USA.
| | - Jill G Joseph
- Betty Irene Moore School of Nursing, UC Davis, Sacramento, CA, USA.
| |
Collapse
|
19
|
Ip P, Ho FKW, Chan KL, Yip PSF, Lau JTF, Wong WHS, Chow CB, Jiang F. Child maltreatment hospitalisations in Hong Kong: incidence rate and seasonal pattern. Arch Dis Child 2016; 101:1107-1113. [PMID: 27390364 DOI: 10.1136/archdischild-2015-310151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/11/2016] [Accepted: 06/21/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We investigated the incidence and seasonal patterns of child maltreatment hospitalisations in Hong Kong. DESIGN A retrospective study of subjects aged under 19 years with a primary diagnosis of child maltreatment admitted to hospitals in Hong Kong from 2001 to 2010. Data were retrieved from the centralised database of all 42 public hospitals in the Hospital Authority. MAIN OUTCOME MEASURES Child maltreatment incidence rate. RESULTS A consistent seasonal pattern was found for non-sexual maltreatment in children aged 6-18 years (p<0.001). Hospitalisations peaked in May and October but dipped in August and January. No significant seasonal patterns were found for sexual maltreatment or among children under 6 years. The seasonal pattern of child maltreatment coincided with the two school examination periods. The annual child maltreatment hospitalisation rate in Hong Kong in 2010 was 73.4 per 100 000 children under 19 years, more than double that in 2001. CONCLUSIONS A peculiar seasonal pattern and an alarming increasing trend in child maltreatment hospitalisation were observed in Hong Kong, which we speculated to be related to school examination stress and increasing socioeconomic disparity. Our findings highlighted differences in the trends of child maltreatment between Hong Kong and the West. Professionals and policymakers should be made aware of these trends and develop effective strategies to tackle child maltreatment.
Collapse
Affiliation(s)
- Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Frederick Ka-Wing Ho
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ko Ling Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
| | - Paul Siu-Fai Yip
- Centre for Suicide Prevention and Research, The University of Hong Kong, The University of Hong Kong, Hong Kong, Hong Kong
| | - Joseph Tak-Fai Lau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Wilfred Hing-Sang Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Chun-Bong Chow
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
20
|
Bousema S, Stas HG, van de Merwe MH, Oen IM, Baartmans MG, van Baar ME, Dokter J, van Es A, van der Vlies C, van Baar M. Epidemiology and screening of intentional burns in children in a Dutch burn centre. Burns 2016; 42:1287-94. [DOI: 10.1016/j.burns.2016.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/24/2015] [Accepted: 01/03/2016] [Indexed: 11/28/2022]
|
21
|
Leaman LA, Hennrikus WL, Bresnahan JJ. Identifying non-accidental fractures in children aged <2 years. J Child Orthop 2016; 10:335-41. [PMID: 27339476 PMCID: PMC4940250 DOI: 10.1007/s11832-016-0755-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/14/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Fractures are the second most common presentation of child abuse following soft-tissue bruising and burns. It is often difficult to determine potential abuse in a child presenting with a non-rib fracture(s) and without soft-tissue injuries. METHODS One hundred and fifteen consecutive patients aged ≤2 years who presented with a fracture between January 2010 and June 2012 to our emergency department (ED) or pediatric fracture clinic were retrospectively analyzed. Statistical analyses were carried out for non-accidental fractures based on age (<1 year vs 1-2 years), location of presentation (ED vs pediatric fracture clinic), type of long bone fracture, number of fractures, and patient demographics. RESULTS Fractures in 19 of 115 (17 %) patients were reported as non-accidental trauma (NAT). Eighty (70 %) of the 115 patients first reported to the ED. Thirty-two percent of fractures in children aged <1 year and 5 % of fractures in children aged 1-2 years were reported as NAT (p < 0.001). Sixteen of 19 (84 %) patients reported for abuse had multiple fractures; 15 of these patients were aged <1 year. Eight of 11 (73 %) reported femoral fractures were transverse fractures. Corner fractures (12) only occurred in children aged <1 year and never occurred in isolation; all of them were reported as NAT. Four of 60 patients (7 %) with commercial insurance and 15 of 55 patients (28 %) with Medicaid were reported as NAT. CONCLUSIONS Age less than 1 year, multiple fractures, corner fractures, transverse fractures, and covered by Medicaid were the most common factors associated with reporting of NAT.
Collapse
Affiliation(s)
- Laura A Leaman
- Department of Family Medicine, Lancaster General Health, Lancaster, PA, USA
| | - William L Hennrikus
- Department of Orthopaedics and Rehabilitation, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - James J Bresnahan
- Department of Orthopaedics and Rehabilitation, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
- Pennsylvania State University College of Medicine, 500 University Dr., Hershey, PA, United States.
| |
Collapse
|
22
|
Van Scoyoc A, Wilen JS, Daderko K, Miyamoto S. Multiple Aspects of Maltreatment: Moving Toward a Holistic Framework. ADVANCES IN CHILD ABUSE PREVENTION KNOWLEDGE 2015. [DOI: 10.1007/978-3-319-16327-7_2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
23
|
Chien WC, Chung CH, Pai L, Kao S, Chiu YL, Cheng CH. Analysis of national empirical data on the characteristics and trends of injury among Taiwan's victims of hospitalized child abuse between 1997 and 2009. VIOLENCE AND VICTIMS 2013; 28:403-413. [PMID: 23862306 DOI: 10.1891/0886-6708.11-00142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To investigate the characteristics and trends of injury among hospitalized child abuse children younger than 18 years between 1997 and 2009. METHODS We selected hospitalized child abuse cases from the Taiwan's National Health Insurance (NHI) Database in accordance with ICD-9-CM 995.5x or E967.x. RESULTS There were 1,212 victims of hospitalized child abuse during the research period, including 735 boys and 477 girls. The victims were most frequently inflicted by the father or stepfather, and the most common injury was intracranial damage; besides, the victims most commonly sought treatment in medical centers. Infants younger than 1 year accounted for the highest percentage of hospitalized victims. Although there were no apparent trends in the overall hospitalization rate of the child abuse victims over the 13-year period, the rate of abuse among girls increased gradually over the years. CONCLUSIONS The medical staff in hospitals should provide appropriate treatment to the victims and contact relevant organizations to intervene; moreover, government agencies should formulate effective control measures to develop a safe growth environment for children.
Collapse
|
24
|
Trenchs Sainz de la Maza V, Curcoy Barcenilla AI, Gelabert Colome G, Macias Borras C, Pou Fernández J. [Hospital admissions due to child maltreatment over a fifteen year period]. An Pediatr (Barc) 2012; 78:118-22. [PMID: 22796057 DOI: 10.1016/j.anpedi.2012.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 04/11/2012] [Accepted: 05/30/2012] [Indexed: 11/30/2022] Open
Abstract
AIM To measure the incidence of admissions for maltreatment between 1995 and 2009 and to determine their main clinical and epidemiological characteristics. METHODS Retrospective review of children diagnosed with maltreatment over 15 years in a third level hospital. RESULTS A total of 97 cases (median incidence 0.5 cases per 1000 children admitted per year) were found. There was an increasing rate of physical maltreatment, while those of sexual abuse declined. 51 (53.6%) female; median age 3.3 years (p25-75: 7.6 months-10.0 years). Just under half (43.3%) or 42 patients, had a primary complaint unrelated to abuse. The most common injuries were haematomas (43; 44.3%). In 91 (93.8%) cases the perpetrator was found to be a member of the child's own family (77; 74.9%, one of the parents or both). CONCLUSIONS The increase in admissions for physical maltreatment stresses the need to insist in a prevention policy. The decrease in admissions for sexual abuse was probably attributable to changes in the care circuit rather than a real decrease. In almost half of the cases the suspicion of maltreatment arose upon physical examination or after complementary tests, making it advisable that maltreatment is included in the differential diagnosis in multiple consultations. The majority of maltreatment occurred in the context of the victim's family.
Collapse
|
25
|
Indirect Traumas Affecting The Posterior Segment. Clin Ophthalmol 2012; 52:167-80. [DOI: 10.1097/iio.0b013e31823bbc64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
26
|
|