Skellern C Y, Wood D O, Murphy A, Crawford M
Child Protection Unit, Mater Children's Hospital, South Brisbane, Queensland, Australia.
J Paediatr Child Health. 2000 Dec;36(6):590-2. doi: 10.1046/j.1440-1754.2000.00592.x.
To look for features of non-accidental fractures in infants aged under I year and assess the risk of subsequent morbidity and mortality.
A retrospective analysis of 99 children aged under 1 year who presented to the Mater Children's Hospital, Brisbane, between January 1990 and December 1993, and were found to have a fracture. The 99 infants were divided into non-accidental and accidental groups. Comparison was made between the two groups for age, sex and type of fracture. Deaths, subsequent injuries and child protection notifications until March 1997 were compared between groups.
Of the 99 infants with fracture (64 males, 35 female), the skull and femur were the most prevalent sites of fracture. Twenty-six infants had fractures assessed as non-accidental. This group was younger but did not differ significantly in gender or site of fracture. Infants aged under 4 months had a significantly greater risk of their fracture being non-accidental (P = 0.0007). Subsequent substantiated child protection notifications occurred in nine of the non-accidental group and in one of the accidental group (P = 0.000001). There was no significant difference in the rate of subsequent notifications between those infants with abuse who were removed from their carers and those not removed. Subsequent injuries presenting to hospital occurred in 17 of the accidental group and three of the non-accidental group (P = 0.20). There were no deaths.
Infants aged under 1 year with fractures have a high prevalence of abuse. The risk of abuse as cause for the fracture is greater in those aged under 4 months. Infants with non-accidental fractures have a high risk of further abuse even with intervention.
寻找1岁以下婴儿非意外骨折的特征，并评估其随后发病和死亡的风险。
对1990年1月至1993年12月间在布里斯班 Mater 儿童医院就诊且被发现有骨折的99名1岁以下儿童进行回顾性分析。这99名婴儿被分为非意外组和意外组。对两组的年龄、性别和骨折类型进行比较。比较两组直至1997年3月的死亡情况、后续受伤情况以及儿童保护通报情况。
在99名骨折婴儿中（64名男性，35名女性），颅骨和股骨是最常见的骨折部位。26名婴儿的骨折被评估为非意外骨折。该组年龄较小，但在性别或骨折部位上无显著差异。4个月以下的婴儿骨折为非意外骨折的风险显著更高（P = 0.0007）。非意外组中有9名婴儿随后得到了儿童保护通报的证实，而意外组中只有1名（P = 0.000001）。从照顾者身边被带走的受虐婴儿和未被带走的受虐婴儿在后续通报率上没有显著差异。意外组中有17名婴儿随后因伤住院，非意外组中有3名（P = 0.20）。无死亡病例。
1岁以下骨折婴儿受虐情况普遍。4个月以下婴儿因骨折而受虐的风险更大。即使进行了干预，非意外骨折的婴儿仍有遭受进一步虐待的高风险。
