Abstract
Aim
Fractures are the second commonest presentation of non-accidental injury (NAI) in children. Approximately one third of abused children will present to Acute Trauma Services (ATS) with fractures. Any cases of suspected child maltreatment should be referred to Safeguarding Services for follow-up, as outlined by Trust Guidelines. Our aim was to examine the referral of children with suspicious fractures to safeguarding and assess if cases with high risk of abuse are being missed by ATS.
Method
A comprehensive literature review identified commonly cited indicators of abuse. Inclusion criteria included age less than 18 months seen in A&E or Fracture Clinic with a long bone fracture. Patient notes were analysed to identify occurrence of these risk factors and findings cross-referenced with Safeguarding Services' records to verify whether high-risk patients were detected. The origin of each referral was also noted.
Results
The cohort consisted of 28 patients, nine had records with Safeguarding Services. The remaining 19 were not thought to be at significant risk to alert Safeguarding and have not subsequently come to their attention due to physical abuse. An average of two risk factors was seen (range 1–5) and the patient with five risk factors was investigated by Safeguarding. The most common risk factors were ‘unclear mechanism of injury’ and ‘un-witnessed injury’. The most specific for abuse were ‘suspicious history’ and ‘previous injury’. Out of five patients with metaphyseal fractures, only one was known to Safeguarding Services. The remaining four patients had relatively few risk factors.
Conclusion
Children with the highest number of risk factors were detected and referred to Safeguarding. Some with few risk factors were also referred, suggesting ATS are sensitive to signs of abuse in a clinical history. Our study indicates metaphyseal fractures are not necessarily highly predictive of NAI and may be related to patients' ages.
