Fractures in children younger than age 1 year: importance of collaboration with child protection services.

摘要: The medical records of all children less than 1 year age presenting to the Accident and Emergency Department over a 5-year period (1995-1999) with fracture were retrospectively reviewed for possible abuse. Seventy-four presented fractures during study period, mean at presentation 5 months (range 2 weeks year). Of these children, 46 had skull 28 long bone fractures. Children classified into one seven categories: definite abuse, likely suspicious, accident, neglect, or unknown cause. A three-tier system grading abuse was then used analyze variance. first tier consisted initial assessment by staff clinicians, second an orthopaedic registrar, third designated doctor in child protection (consultant pediatrician), using same information from case notes. use demonstrated variance diagnosis nonaccidental injury. possibility underestimated time original injury quarter cases (28.4%) when compared consultant pediatrician. In 34 (46%), there no written documentation that ever considered. While management depends on local guidelines arrangements, authors would advise under should be admitted hospital referred pediatrician assessment.