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Results

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.

 

Overall results for rib fractures

  • Out of 540 studies reviewed, 18 studies addressed rib fractures 1-18
  • Study designs:
    • 8 cross-sectional (one with subseries) 2-5,6,8,10,13,16,17
    • 2 case-control 12,18
    • 6 case study / case series 1,5,7,9,11,14,15
  • Age range: 0-15 years
    • In children less than four years of age rib fractures were more commonly found in those abused than those accidentally injured 6,12

    • In those aged less than 18 months with rib fractures the odds ratio (OR) for abuse was 23.7 (95%CI 9.5, 59.2) (p<0.001) 12

    • In those aged over 18 months with rib fractures the OR for abuse was 9.1 (95%CI 3.3, 25) (p<0.001) 12

  • Ten had a high abuse ranking of one or two 2-5,6,9,12,14,15,18
  • No study addressed disabled children
  • No study addressed the influence of ethnicity and socio-economic group

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References

  1. Barber I, Perez-Rossello JM, Wilson CR, Kleinman PK. The yield of high-detail radiographic skeletal surveys in suspected infant abuse. Pediatric Radiology. 2015;45(1):69-80 [Pubmed]

  2. Barsness KA, Cha ES, Bensard DD, Calkins CM, Partrick DA, Karrer FM, Strain JD. The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. Journal of Trauma - Injury Infection & Critical Care. 2003;54(6):1107-1110 [Pubmed]
  3. Bulloch B, Schubert CJ, Brophy PD, Johnson N, Reed MH, Shapiro RA. Cause and clinical characteristics of rib fractures in infants. Pediatrics. 2000;105(4):E48 [Pubmed]
  4. Cadzow SP, Armstrong KL. Rib fractures in infants: red alert! The clinical features, investigations and child protection outcomes. Journal of Paediatrics and Child Health. 2000;36(4):322-326 [Pubmed]
  5. Cosway B, Mathura N, Mott A, Bredow M, Fraser J, Rawlinson A, Wei C, Thyagarajan M, Harrison S, Kemp A. Occult rib fractures: Defining the cause. Child Abuse Review. 2013. [Early View - Abstract available from Wiley online library]

  6. Darling SE, Done SL, Friedman SD, Feldman KW. Frequency of intrathoracic injuries in children younger than 3 years with rib fractures. Pediatric Radiology. 2014;44(10):1230-1236 [Pubmed]

  7. Feldman KW, Brewer DK. Child abuse, cardiopulmonary resuscitation, and rib fractures. Pediatrics. 1984;73(3):339-342 [Pubmed]
  8. Garcia VF, Gotschall CS, Eichelberger MR, Bowman LM. Rib fractures in children: a marker of severe trauma. The Journal of Trauma. 1990;30(6):695-700 [Pubmed]
  9. Gipson CL, Tobias JD. Flail chest in a neonate resulting from nonaccidental trauma. Southern Medical Journal. 2006;99(5):536-538 [Pubmed]
  10. Leventhal JM, Thomas SA, Rosenfield NS, Markowitz RI. Fractures in young children. Distinguishing child abuse from unintentional injuries. American Journal of Diseases of Children. 1993;147(1):87-92 [Pubmed]
  11. Ng CS, Hall CM. Costochondral junction fractures and intra-abdominal trauma in non-accidental injury (child abuse). Pediatric Radiology. 1998;28(9):671-676 [Pubmed]
  12. Pandya NK, Baldwin K, Wolfgruber H, Christian CW, Drummond DS, Hosalkar HS. Child abuse and orthopaedic injury patterns: analysis at a level I pediatric trauma center. Journal of Pediatric Orthopaedics. 2009;29(6):618-625 [Pubmed]
  13. Schweich P, Fleisher G. Rib fractures in children. Pediatric Emergency Care. 1985;1(4):187-189 [Pubmed]
  14. Smeets AJ, Robben SG, Meradji M. Sonographically detected costo-chondral dislocation in an abused child. A new sonographic sign to the radiological spectrum of child abuse. Pediatric Radiology. 1990;20(7):566-567 [Pubmed]
  15. Smith FW, Gilday DL, Ash JM, Green MD. Unsuspected costo-vertebral fractures demonstrated by bone scanning in the child abuse syndrome. Pediatric Radiology. 1980;10(2):103-106 [Pubmed]
  16. Strouse PJ, Owings CL. Fractures of the first rib in child abuse. Radiology. 1995;197(3):763-765 [Pubmed]
  17. Thomas PS. Rib fractures in infancy. Annales de Radiologie. 1977;20(1):115-122 [Pubmed]
  18. Worlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study. British Medical Journal (Clinical Research Edition). 1986;293(6539):100-102 [Pubmed]

 

Meta-analysis

  • Of the studies included up to 2012, seven were suitable for meta-analysis 1-4, 6-8
  • However since 2013 we have restricted the meta-analysis to children less than 48 months of age 1,3,5,7
  • These four studies include children with confirmed or suspected abuse but showed no heterogeneity (I2=0%)
  • The positive predictive value for rib fractures in relation to suspected or confirmed abuse is 66% (95% confidence interval 42.5-89.7)
  • The key new study was a very large-scale case-control study 5

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References

  1. Barsness KA, Cha ES, Bensard DD, Calkins CM, Partrick DA, Karrer FM, Strain JD. The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. Journal of Trauma - Injury Infection & Critical Care. 2003;54(6):1107-1110 [Pubmed]
  2. Bulloch B, Schubert CJ, Brophy PD, Johnson N, Reed MH, Shapiro RA. Cause and clinical characteristics of rib fractures in infants. Pediatrics. 2000;105(4):E48 [Pubmed]
  3. Cadzow SP, Armstrong KL. Rib fractures in infants: red alert! The clinical features, investigations and child protection outcomes. Journal of Paediatrics and Child Health. 2000;36(4):322-326 [Pubmed]
  4. Garcia VF, Gotschall CS, Eichelberger MR, Bowman LM. Rib fractures in children: a marker of severe trauma. The Journal of Trauma. 1990;30(6):695-700 [Pubmed]
  5. Pandya NK, Baldwin K, Wolfgruber H, Christian CW, Drummond DS, Hosalkar HS. Child abuse and orthopaedic injury patterns: analysis at a level I pediatric trauma center. Journal of Pediatric Orthopaedics. 2009;29(6):618-625 [Pubmed]
  6. Schweich P, Fleisher G. Rib fractures in children. Pediatric Emergency Care. 1985;1(4):187-189 [Pubmed]
  7. Strouse PJ, Owings CL. Fractures of the first rib in child abuse. Radiology. 1995;197(3):763-765 [Pubmed]
  8. Thomas PS. Rib fractures in infancy. Annales de Radiologie. 1977;20(1):115-122 [Pubmed]

 

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