Less than half of infants with humeral or femoral fractures are assessed by a paediatrician for physical abuse in some hospitals in East Anglia. The finding comes from the retrospective East Anglia Paediatric Physical Abuse and Fractures study which was conducted in 7 hospitals across the region.
The research, led by Peterborough City Hospital, audited data on young children presenting with fracture between 1 January 2009 and 31 December 2012. Inclusion criteria were all children under 12 months of age with a fracture to limb or spine, and all children under 3 years with a fracture to any part of the femur, or to the shaft or proximal part of the humerus. The data were linked to decisions of a multi-agency child protection case conference (CPCC).
Over the 4-year study period, the number of children considered to be at high risk for abuse was 282. The total number of children where a CPCC decided that physical abuse had taken place was 29.
The proportion of high-risk fractures assessed by a paediatrician was 49-75% in all included children and 46-86% for infants. The most common limb fracture sites in infants were the femur, tibia/fibula, radius/ulna, humerus and clavicle. Injuries ranged from 1 to 6 fractures in the same infant. Extremity injuries of the hand and feet in this age group were rare.
Based on the findings, the authors propose guidelines to identify children who should be assessed by a paediatrician.
They propose that all infants under 12 months of age with any fracture should be assessed by paediatrics. The same is recommended for children of up to 18 months of age with a femur fracture, and up to 24 months with a humerus shaft fracture.
