Dominguez Michelle M, Moore Jessica L, Cook Megan, Rogers Michelle L, McCarten Kathleen, Slingsby Brett
From the Division of Pediatrics, Department of Pediatrics, The Alpert Medical School of Brown University.
Department of Pediatrics, Alpert Medical School of Brown University.
Pediatr Emerg Care. 2022 Dec 1;38(12):e1678-e1683. doi: 10.1097/PEC.0000000000002877. Epub 2022 Nov 10.
This study aimed to describe which infants with a skull fracture (1) receive a child abuse pediatrician (CAP) consultation, (2) receive a skeletal survey, and (3) re-present to medical care before age 3 years with concerns for physical abuse.
We conducted a retrospective chart review of infants younger than 12 months who presented to the emergency department between January 1, 2005, and December 30, 2015, with a skull fracture. Medical records were reviewed for the skull fracture presentation and for all future medical evaluations at the same institution with concerns for physical abuse until 3 years of age.
Of 366 infants with a skull fracture, a CAP was contacted for 272 (74%) and 76 (20.8%) infants who received a skeletal survey. Factors associated with skeletal survey acquisition included younger age (<6 months), no history to explain the skull fracture, other injuries on examination, and social risk factors. Six children (1.6%) re-presented to medical care with concerns of physical abuse before age 3 years. Five of these infants did not have a skeletal survey at the time of their skull fracture, and 1 was likely a case of missed physical abuse at the time of the skull fracture.
Most skull fractures in infancy occur accidentally, and a skeletal survey may not be necessary for every infant. Obtaining a thorough history including social risk factors, performing a complete physical examination, and consulting with a CAP is an effective first step in the evaluation of physical abuse in infants with skull fractures.
本研究旨在描述哪些颅骨骨折婴儿（1）接受了儿童虐待儿科医生（CAP）会诊，（2）接受了骨骼检查，以及（3）在3岁前因身体虐待问题再次就医。
我们对2005年1月1日至2015年12月30日期间因颅骨骨折到急诊科就诊的12个月以下婴儿进行了回顾性病历审查。审查了病历中颅骨骨折的情况以及该机构在3岁前对所有未来因身体虐待问题进行的医学评估。
在366例颅骨骨折婴儿中，272例（74%）联系了CAP，76例（20.8%）婴儿接受了骨骼检查。与进行骨骼检查相关的因素包括年龄较小（<6个月）、无解释颅骨骨折的病史、检查时有其他损伤以及社会风险因素。6名儿童（1.6%）在3岁前因身体虐待问题再次就医。其中5例婴儿在颅骨骨折时未进行骨骼检查，1例可能是颅骨骨折时漏诊的身体虐待病例。
婴儿期的大多数颅骨骨折是意外发生的，并非每个婴儿都需要进行骨骼检查。获取包括社会风险因素在内的详尽病史、进行全面体格检查以及咨询CAP是评估颅骨骨折婴儿身体虐待情况的有效第一步。
