Femur fractures in the pediatric population: abuse or accidental trauma?
Femur fractures in the pediatric population: abuse or accidental trauma?
复制标题
DOI：
10.1007/s11999-010-1339-z
复制
发表时间：
2011-03
影响因子：
4.2
通讯作者：
Hosalkar HS
中科院分区：
文献类型：
--
作者：
Baldwin K;Pandya NK;Wolfgruber H;Drummond DS;Hosalkar HS
虐待儿童对儿童的健康和福祉构成严重威胁。当由于存在骨损伤而怀疑虐待儿童时，矫形专家往往会参与其中。区分虐待和意外创伤可能很困难，通常是基于临床怀疑。我们试图确定是否可以通过结合病史、体格检查结果、影像学检查结果和年龄等推测的风险因素来区分4岁以下儿童患者的意外股骨骨折与虐待儿童。我们搜索了我们机构的SCAN（疑似虐待儿童和虐待儿童）和创伤数据库。我们确定了70例股骨骨折的病因是滥用，并将该组与139例股骨骨折的病因是意外创伤的患者进行了比较。滥用的可疑历史，身体或先前受伤的放射学证据，年龄小于18个月是滥用的风险因素。没有危险因素的患者有4%的机会，有一个危险因素的患者有29%的机会，有两个危险因素的患者有87%的机会，所有三个危险因素的患者有92%的机会股骨骨折是由于滥用。临床医生可以使用这个预测模型来指导判断和转诊到社会服务时，看到非常年幼的儿童在急诊室股骨骨折。三级，诊断研究。有关证据等级的完整描述，请参见作者指南。
Child abuse represents a serious threat to the health and well-being of the pediatric population. Orthopaedic specialists will often become involved when child abuse is suspected as a result of the presence of bony injury. Distinguishing abuse from accidental trauma can be difficult and is often based on clinical suspicion. We sought to determine whether accidental femur fractures in pediatric patients younger than age 4 could be distinguished from child abuse using a combination of presumed risk factors from the history, physical examination findings, radiographic findings, and age. We searched our institution’s SCAN (Suspected Child Abuse and Neglect) and trauma databases. We identified 70 patients in whom the etiology of their femur fracture was abuse and compared that group with 139 patients who had a femur fracture in whom accidental trauma was the etiology. A history suspicious for abuse, physical or radiographic evidence of prior injury, and age younger than 18 months were risk factors for abuse. Patients with no risk factors had a 4% chance, patients with one risk factor had a 29% chance, patients with two risk factors had an 87% chance, and patients with all three risk factors had a 92% chance of their femur fracture being a result of abuse. Clinicians can use this predictive model to guide judgment and referral to social services when seeing femur fractures in very young children in the emergency room. Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
登录
查看更多内容
DOI：
10.1001/archpedi.1993.02160250089028
发表时间：
1993-01-01
影响因子：
--
作者：
LEVENTHAL, JM;THOMAS, SA;MARKOWITZ, RI
通讯作者：
MARKOWITZ, RI
影响因子：
2.3
作者：
Loder, R T;Bookout, C
通讯作者：
Bookout, C
影响因子：
1.4
作者：
Jones, JCW;Feldman, KW;Bruckner, JD
通讯作者：
Bruckner, JD
影响因子：
2.4
作者：
Lynch, JM;Gardner, MJ;Gains, B
通讯作者：
Gains, B
影响因子：
3.1
作者：
McKinney, A;Lane, G;Hickey, F
通讯作者：
Hickey, F