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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 skull fractures

  • Study design:
    2 case-control 7,12
    10 cross-sectional 1-6,8-11
  • Age range: from 0 – 5 years
  • No study addressed disabled children
  • No study addressed the influence of ethnicity and socio-economic group

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References

  1. Billmire ME, Myers PA. Serious head injuries in infants: accident or abuse? Pediatrics. 1985;75(2):340-342 [Pubmed]
  2. Hiss J, Kahana T. The medicolegal implications of bilateral cranial fractures in infants. The Journal of Trauma: Injury, Infection, and Critical Care. 1995;38(1):32-34 [Pubmed]
  3. Kowal-Vern A, Paxton TP, Ros SP, Lietz H, Fitzgerald M, Gamelli RL. Fractures in the under-3-year-old age cohort. Clinical Pediatrics. 1992;31(11):653-659 [Pubmed]
  4. 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]
  5. McClelland CQ, Heiple KG. Fractures in the first year of life. A diagnostic dilemma. American Journal of Diseases of Children. 1982;136(1):26-29 [Pubmed]
  6. Meservy CJ, Towbin R, McLaurin RL, Myers PA, Ball W. Radiographic characteristics of skull fractures resulting from child abuse. American Journal of Roentgenology. 1987;149(1):173-175 [Pubmed]
  7. 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]
  8. Reece RM, Sege R. Childhood head injuries: accidental or inflicted? Archives of Pediatrics and Adolescent Medicine. 2000;154(1):11-15 [Pubmed]
  9. Rosenberg N, Bottenfield G. Fractures in infants: a sign of child abuse. Annals of Emergency Medicine 1982;11(4):178-180 [Pubmed]
  10. Skellern CY, Wood DO, Murphy A, Crawford M. Non-accidental fractures in infants: risk of further abuse. Journal of Paediatrics and Child Health. 2000;36(6):590-592 [Pubmed]
  11. Stewart G, Meert K, Rosenberg N. Trauma in infants less than three months of age. Pediatric Emergency Care. 1993;9(4):199-201 [Pubmed]
  12. 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
  • Since 2013, the meta-analysis has been conducted on children aged 0-48 months 2-6
  • There was no heterogeneity between these studies (I2=0%) and the positive predictive value of a skull fracture for suspected or confirmed abuse was 20.1% (95% confidence interval 13.3-26.9)
  • Contrary to the other fractures analysed, age less than 18 months does not appear to be a key variable 5. In one study, in children aged less than 18 months skull fractures were more common in the control subjects than those who were abused 5

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References

  1. Billmire ME, Myers PA. Serious head injuries in infants: accident or abuse? Pediatrics. 1985;75(2):340-342 [Pubmed]
  2. Kowal-Vern A, Paxton TP, Ros SP, Lietz H, Fitzgerald M, Gamelli RL. Fractures in the under-3-year-old age cohort. Clinical Pediatrics. 1992;31(11):653-659 [Pubmed]
  3. McClelland CQ, Heiple KG. Fractures in the first year of life. A diagnostic dilemma. American Journal of Diseases of Children. 1982;136(1):26-29 [Pubmed]
  4. Meservy CJ, Towbin R, McLaurin RL, Myers PA, Ball W. Radiographic characteristics of skull fractures resulting from child abuse. American Journal of Roentgenology. 1987;149(1):173-175 [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. Reece RM, Sege R. Childhood head injuries: accidental or inflicted? Archives of Pediatrics and Adolescent Medicine. 2000;154(1):11-15 [Pubmed]
  7. Rosenberg N, Bottenfield G. Fractures in infants: a sign of child abuse. Annals of Emergency Medicine 1982;11(4):178-180 [Pubmed]
  8. Stewart G, Meert K, Rosenberg N. Trauma in infants less than three months of age. Pediatric Emergency Care. 1993;9(4):199-201 [Pubmed]

 

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