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Other useful references

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.


  • Histological dating of fractures may be crucial to distinguish abusive from cardiopulmonary resuscitation (CPR) related fractures 1-3
  • Posterior rib fractures in a child who has been resuscitated on a firm surface would appear inconsistent with the biomechanics of resuscitation 4
  • One publication proposed that a 21 month old with fatal head injuries sustained a posterior rib fracture as a consequence of CPR performed by trained personnel 5
    • However, this 21 month child had a co-existent unexplained pelvic fracture and absence of rib fracture prior to CPR was only determined by an abdominal computerised tomography scan 5
    • The paper itself contains much debate as to whether the case was abused or not and the reader cannot confidently conclude that this was a confirmed case of abuse 5
  • CPR technique utilising a mannikin demonstrates that the majority of practitioners are likely to over-compress without real time feedback 6

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  1. Feldman KW, Brewer DK. Child abuse, cardiopulmonary resuscitation, and rib fractures. Pediatrics. 1984;73(3):339-342 [Pubmed]
  2. Gunther WM, Symes SA, Berryman HE. Characteristics of child abuse by anteroposterior manual compression versus cardiopulmonary resuscitation: case reports. American Journal of Forensic Medicine & Pathology. 2000;21(1):5-10 [Pubmed]
  3. Klotzbach H, Delling G, Richter E, Sperhake JP, Puschel K. Post-mortem diagnosis and age estimation of infants' fractures. International Journal of Legal Medicine. 2003;117(2):82-89 [Pubmed]
  4. Kleinman PK, Schlesinger AE. Mechanical factors associated with posterior rib fractures: laboratory and case studies. Pediatric Radiology. 1997;27(1):87-91 [Pubmed]
  5. Plunkett J. Resuscitation injuries complicating the interpretation of premortem trauma and natural disease in children. Journal of Forensic Sciences. 2006;51(1):127-130 [Pubmed]
  6. Martin PS, Kemp AM, Theobald PS, Maguire SA, Jones MD. Does a more "physiological" infant manikin design effect chest compression quality and create a potential for thoracic over-compression during simulated infant CPR? Resuscitation. 2013;84(5):666-71 [Pubmed]


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