Leventhal JM, Thomas SA, Rosenfield NS, Markowitz RI.
Fractures in young children Distinguishing child abuse from unintentional injuries
. AJDC 1993;147:87-92.
Objective:
- To determine what features would be helpful in distinguishing unintentional from intentional (i.e., abusive) fractures in children.
Methods:
- Retrospective study of the medical charts and roentgenograms of children < 3 years of age with fractures.
- Assessments were made using a seven-point scale to rate the likelihood that the fracture was due to abuse.
- The location of fractures resulting from falls as well as the height of the fall as it relates to the presence of a complicated skull fracture were specifically examined.
Results:
- 215 patients had confirmed fractures; mean age 15.7 months
- 130 children suffered fractures from falls (60 percent)
- In 14 (11 percent) children the cause was classified as abuse
- In 12 (9 percent) children the cause was classified as unknown
- In 104 (80 percent) children the cause was classified as unintentional
Number of complicated skull fractures from falls in 104 children in which the cause was classified as unintentional:
|
Height of fall (cm)
|
Number of children (total)
|
Number with skull fractures (%)
|
Running
|
6
|
0 (0%)
|
< 60
|
24
|
8 (33%)
|
60-119
|
33
|
23 (70%)
|
120-210
|
26
|
17 (65%)
|
>210
|
7
|
5 (71%)
|
Unknown
|
8
|
1 (12.5%)
|
Conclusions:
- It is common for children to suffer fractures from falls.
- The greater the height of the fall, the more common it is to suffer a skull fracture.