Recording of risk factors for abuse in children younger than 36 months with fractures: a 12 years retrospective analysis in an Italian General Hospital Emergency Department

OBJECTIVESIn younger children, fractures should be considered suspicious of a non-accidental injury (NAI). The aim of the study was to verify the thoroughness of medical records collected for children younger than 36 months... [ view full abstract ]

OBJECTIVES

In younger children, fractures should be considered suspicious of a non-accidental injury (NAI). The aim of the study was to verify the thoroughness of medical records collected for children younger than 36 months with fractures admitted to Perugia Hospital Emergency Department (ED) and verify radiographic skeletal imaging practices for evaluation of suspected abuse, in comparison with a similar study carried out in the past.

METHODS

A 12 years retrospective analysis was carried out from Database of Perugia Hospital ED from January 2004 to March 2016, for all children younger than 36 months who presented with a long bone or skull fracture. We reviewed patients charts for age, gender, site and type of fracture, outcome of ED visit (hospital admission or discharge), recorded history, suspicion about possible NAI or child protection agency referral.

RESULTS

Between 2004-2016 there were 11.136 access in ED for children younger than 36 months; among them, 417 had long bone or skull fracture. Patients with more than one risk factor for NAI were 22/417 (10 in the group under 12 months). We analised the recording of detectable risk factors for NAI in all medical records. In detail, the injury mechanism was documented only in 81/417 patients (19,42%) and the delay in access to ED in 29% of cases. In none of the cases with more than one risk indicator it has been carried out in-depth examination to rule out inflicted trauma. Only in one case the radiology report expressed a suspicion of non accidental fracture.

CONCLUSIONS

Our retrospective study analyzed a high number of cases  in a long period of time. It confirmed previous literature data about fractures in young children, the poor quality of documentation in our Hospital ED and the need both for a structured medical form and training for health professionals.