Rare Diseases Symptoms Automatic Extraction
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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
"late group"
symptom
child syndrome
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