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Long bone fracture

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.

 

  • Full skeletal surveys were not performed in all cases of suspected abusive head trauma (AHT) 1-9
  • In a child with intracranial injury and long bone fracture the positive predictive value for AHT is 59% (95% confidence interval (CI) 48%-69%) and odds ratio 1.7 (95%CI 0.8 – 3.6) 1-9

A combination of long bone fractures (including metaphyseal fractures) and intracranial injury is associated with AHT, however the figures do not reach statistical significance (this may be due to the small numbers recorded)

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References

  1. Ettaro L, Berger RP, Songer T. Abusive head trauma in young children: characteristics and medical charges in a hospitalized population. Child Abuse and Neglect. 2004;28(10):1099-1111 [Pubmed]
  2. Ewing-Cobbs L, Kramer L, Prasad M, Canales DN, Louis PT, Fletcher JM, Vollero H, Landry SH, Cheung K. Neuroimaging, physical, and developmental findings after inflicted and noninflicted traumatic brain injury in young children. Pediatrics 1998;102(2 Pt 1):300-307 [Pubmed]
  3. Hobbs C, Childs AM, Wynne J, Livingston J, Seal A. Subdural haematoma and effusion in infancy: an epidemiological study. Archives of Disease in Childhood. 2005;90(9):952-955 [Pubmed]
  4. Hoskote A, Richards P, Anslow P, McShane T. Subdural haematoma and non-accidental head injury in children. Child's Nervous System. 2002;18(6-7):311-317 [Pubmed]
  5. Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF. A population-based comparison of clinical and outcome characteristics of young children with serious inflicted and noninflicted traumatic brain injury. Pediatrics. 2004;114(3):633-639 [Pubmed]
  6. Kemp AM, Stoodley N, Cobley C, Coles L, Kemp KW. Apnoea and brain swelling in non-accidental head injury. Archives of Disease in Childhood. 2003;88(6):472-476, discussion 476 [Pubmed]
  7. Ruppel RA, Kochanek PM, Adelson PD, Rose ME, Wisniewski SR, Bell MJ, Clark RS, Marion DW, Graham SH. Excitatory amino acid concentrations in ventricular cerebrospinal fluid after severe traumatic brain injury in infants and children: the role of child abuse. Journal of Pediatrics 2001;138(1):18-25 [Pubmed]
  8. Shugerman RP, Paez A, Grossman DC, Feldman KW, Grady MS. Epidural hemorrhage: is it abuse? Pediatrics. 1996;97(5):664-648 [Pubmed]
  9. Tzioumi D, Oates RK. Subdural hematomas in children under 2 years. Accidental or inflicted? A 10-year experience. Child Abuse and Neglect. 1998;22(11):1105-1112 [Pubmed]

 

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