Selective Skeletal Surveys for Infants with Skull Fractures: Examining the Rates of Return to Medical Care for Concern of Physical Abuse
Pediatric Emergency Care, ISSN: 1535-1815, Vol: 38, Issue: 12, Page: E1678-E1683
2022
- 1Citations
- 7Captures
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Article Description
Objectives This study aimed to describe which infants with a skull fracture (1) receive a child abuse pediatrician (CAP) consultation, (2) receive a skeletal survey, and (3) re-present to medical care before age 3 years with concerns for physical abuse. Methods We conducted a retrospective chart review of infants younger than 12 months who presented to the emergency department between January 1, 2005, and December 30, 2015, with a skull fracture. Medical records were reviewed for the skull fracture presentation and for all future medical evaluations at the same institution with concerns for physical abuse until 3 years of age. Results Of 366 infants with a skull fracture, a CAP was contacted for 272 (74%) and 76 (20.8%) infants who received a skeletal survey. Factors associated with skeletal survey acquisition included younger age (<6 months), no history to explain the skull fracture, other injuries on examination, and social risk factors. Six children (1.6%) re-presented to medical care with concerns of physical abuse before age 3 years. Five of these infants did not have a skeletal survey at the time of their skull fracture, and 1 was likely a case of missed physical abuse at the time of the skull fracture. Discussion Most skull fractures in infancy occur accidentally, and a skeletal survey may not be necessary for every infant. Obtaining a thorough history including social risk factors, performing a complete physical examination, and consulting with a CAP is an effective first step in the evaluation of physical abuse in infants with skull fractures.
Bibliographic Details
http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85143180608&origin=inward; http://dx.doi.org/10.1097/pec.0000000000002877; http://www.ncbi.nlm.nih.gov/pubmed/36355046; https://journals.lww.com/10.1097/PEC.0000000000002877; https://dx.doi.org/10.1097/pec.0000000000002877; https://journals.lww.com/pec-online/abstract/2022/12000/selective_skeletal_surveys_for_infants_with_skull.16.aspx
Ovid Technologies (Wolters Kluwer Health)
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