Brigham and Women's Hospital, Department of Emergency Medicine, 75 Francis St, Neville House, Boston, MA 02115, USA.
Pediatrics. 2010 Feb;125(2):e295-9. doi: 10.1542/peds.2009-1478. Epub 2010 Jan 18.
Consensus recommendations state that a radiographic skeletal survey is mandatory for all children <2 years of age with concern for physical abuse. It has been suggested that patients with burns may represent a special subgroup at lower risk for occult fractures, compared with other abused children. Our objective was to determine the prevalence of fractures in children referred for subspecialty abuse evaluations because of burns.
We performed retrospective analyses of data collected as part of the Using Liver Transaminases to Recognize Abuse (ULTRA) research network. Data were collected for all children <5 years of age who were referred to 19 child protection teams for subspecialty child abuse evaluations over 1 year (N = 1676). We compared the rate of fractures in children presenting with burns with that in other children evaluated for abuse.
Of 97 children <24 months of age with burns, 18 (18.6%) were also found to have fractures. Among all 1203 children <24 months of age, 649 (53.9%) had fractures. Eleven children had multiple fractures, and 12 children had fractures with radiographic evidence of healing. Two children were noted to have classic metaphyseal fractures.
The rate of fractures in children who present with burns and concerns regarding physical abuse is sufficient to support the recommendation for routinely performing skeletal surveys for children <2 years of age.
共识建议指出，对于所有<2 岁且疑似遭受身体虐待的儿童，均需进行骨骼放射性检查。有研究表明，与其他受虐儿童相比，烧伤患儿可能属于隐匿性骨折风险较低的特殊亚组。本研究旨在确定因烧伤而接受专科虐待评估的患儿中骨折的发生率。
我们对 ULTRA 研究网络收集的数据进行了回顾性分析。该研究共纳入 1676 名<5 岁且在 1 年内因疑似虐待而被 19 个儿童保护小组转介至专科进行儿童虐待评估的儿童。我们比较了因烧伤就诊且存在骨折患儿与因虐待就诊但不存在骨折患儿的骨折发生率。
97 名<24 月龄且存在烧伤的患儿中，18 名（18.6%）还存在骨折。在所有<24 月龄的 1203 名患儿中，649 名（53.9%）存在骨折。11 名患儿存在多处骨折，12 名患儿存在有放射影像学愈合证据的骨折。2 名患儿存在典型干骺端骨折。
存在烧伤且疑似遭受身体虐待的患儿中骨折的发生率足以支持推荐对<2 岁的儿童常规进行骨骼检查。
