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Are abusive fractures in young children becoming less common? Changes over 24 years.
[child syndrome]
To
determine
whether
the
proportion
of
fractures
rated
as
abusive
in
children
<
36
months
of
age
evaluated
at
a
regional
pediatric
hospital
increased
over
a
24
-
year
period
from
1979
to
2002
.
Fractures
were
chosen
as
an
example
of
serious
injuries
in
young
children
.
Medical
records
were
abstracted
for
all
children
<
36
months
of
age
who
were
seen
at
a
single
pediatric
hospital
with
a
fracture
during
three
time
periods
:
1979
-
1983
,
1991
-
1994
,
and
1999
-
2002
.
After
reviewing
the
abstracted
and
radiographic
information
,
two
clinicians
(
one
an
expert
on
child
abuse
)
and
two
pediatric
radiologists
each
rated
the
likelihood
of
abuse
using
explicit
criteria
and
a
seven
-point
scale
from
definite
abuse
to
definite
unintentional
injury
.
Ratings
were
done
independently
;
when
disagreements
occurred
,
the
case
was
discussed
,
and
a
joint
rating
was
agreed
upon
,
if
possible
.
The
proportions
of
cases
rated
as
abuse
were
compared
over
the
three
time
periods
,
and
logistic
regression
was
used
to
calculate
adjusted
odds
ratios
(
OR
)
.
In
the
early
,
middle
,
and
late
samples
,
there
were
200
,
240
,
and
232
children
,
respectively
,
with
fractures
.
The
proportion
of
cases
rated
as
abuse
decreased
from
22
.
5
%
in
the
early
period
to
10
.
0
%
in
the
middle
period
and
was
10
.
8
%
in
the
late
period
(
p
<
.
001
)
.
When
comparing
the
odds
of
abuse
in
the
middle
and
late
groups
to
the
odds
of
abuse
in
the
early
group
(
controlling
for
age
,
gender
,
ethnicity
,
type
of
medical
insurance
,
and
site
of
pediatric
care
)
,
the
adjusted
ORs
were
.
31
(
95
%
CI
=
.
15
,
.
62
)
for
the
middle
group
and
.
45
(
95
%
CI
=
.
23
,
.
86
)
for
the
late
group
.
Thus
,
the
odds
of
a
given
case
being
rated
as
abuse
decreased
by
over
50
%
from
the
early
period
to
the
middle
and
late
time
periods
.
No
statistically
significant
difference
was
found
when
comparing
the
odds
of
abuse
for
the
middle
group
to
those
of
the
late
group
,
OR
:
1
.
46
(
95
%
CI
=
.
69
,
3
.
08
)
.
The
proportion
of
abusive
fractures
in
young
children
decreased
substantially
from
1979
-
1983
to
1991
-
1994
and
1999
-
2002
at
a
major
pediatric
hospital
.
We
speculate
that
this
decrease
may
reflect
early
recognition
of
less
serious
forms
of
maltreatment
and
the
availability
of
services
to
high
-risk
families
.
Diseases
Validation
Diseases presenting
"early recognition"
symptom
22q11.2 deletion syndrome
cadasil
child syndrome
cowden syndrome
cushing syndrome
cystinuria
familial mediterranean fever
homocystinuria without methylmalonic aciduria
kindler syndrome
legionellosis
oligodontia
omenn syndrome
pyomyositis
thoracic outlet syndrome
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