P0861 - What percent of pediatric femur fractures result from non-accidental trauma?

Purpose: Fractures are the second most common clinical manifestation of child abuse, with the femur being the most common location for non-accidental trauma (NAT) related fractures. The reported proportion of pediatric femur fractures that result from NAT varies drastically in the literature, ranging 21% to 60%. The purpose of this study is to further assess what ratio of pediatric femur fractures are the result of NAT, and to examine the effect of patient age range on NAT prevalence.

Methods: Retrospective review of patients 0 to 36-months old diagnosed with a femur fracture between 1/1/04 and 4/9/19 at our institution. Patients with incomplete medical records were excluded. Incomplete medical records were defined as an absence of all femur fracture related documentation. NAT was defined as a positive workup, meaning NAT was identified via social services, skeletal survey, or ophthalmological exam.

Results: 299 patients were identified. 22 patients were excluded due to incomplete medical records. 37 patients had no mention of an NAT workup entirely. 43 patients did not undergo NAT workup due to lack of suspicion. 197 patients underwent an NAT workup. 16.2% (32/197) of patient femur fractures were determined to be the result of NAT.

Of the 32 patients with NAT, 12 were female and 20 were male. The average age at presentation was 0.7 years old. Additional injuries were present in 40.6% (13/32) patients. A significant difference in NAT rates was found between the 0 to 12-month age group and both older age groups, X2 (2, N = 277) = 35.1026, p < .00001.

Conclusion: Over one quarter (28.9%) of patients seen for femur fractures were not screened for NAT as is recommended by the American Academy of Orthopaedic Surgeons Guidelines and Evidence Report. Of the patients that were screened, 16.2% (32/197) of patient femur fractures were determined to be the result of NAT.