Incidence and 12-Month Outcomes of Fracture Types Associated with Abuse in Children Under Three Years Old Presenting to an Emergency Department

Background: Child physical abuse is a significant contributor to overall pediatric mortality and morbidity and is associated with both short- and long-term effects on the physical, social and mental wellbeing of the child involved. Fractures are the second most common physical injury in children suffering from physical abuse and are present in up to 55% of cases of physically abused children. Specific fracture patterns may prompt suspicion for abuse, although none are specific. We aim to identify the incidence of fracture types associated with abuse in children under three years old presenting to the ED. Methods: This study was a retrospective descriptive study. The inclusion criteria consisted of (a) children less than three years of age, (b) presenting to the ED, (c) between 1 January 2020, and 31 December 2022, inclusive and (d) with a diagnosis consistent with a fracture type associated with abuse. Results: There were 214 patients diagnosed with fractures who were under 3 years of age. Of these, twenty-one patients fit the criteria for fracture suspcious for non-accidental injury (a rate of one per month if following a normal distribution). The diagnosis of NAI was considered in eight (38%) patients. NAI was not considered in 13 (62%) patients. A medical record review of these patients up to 12 months after initial ED presentation showed that five did not re-present to the ED, one was referred to CSS from outpatients and two re-presented within this period with minor head injuries. Conclusions: Presentations of fractures concerning NAI are rare but important not to miss. Automated systems and targeted education and action are critical to ensure that concerns for NAI are managed appropriately.