G39(P) Children presenting to the ED with fractures; is there a lack of awareness of non-accidental injury?

• Published in: Archives of disease in childhood Vol. 99; no. Suppl 1; p. A17
• Main Authors: Payne, E, Murch, H, Woolley, C
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.04.2014
• Subjects: Child Abuse; Coding; Developmental stages; Injuries; Medical personnel; Risk factors; Social services
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2014-306237.39

Aims Fractures are an extremely common presentation to the ED, most frequently due to an accidental cause. However it is known that fractures in children are the second most common presentation of child abuse. Risk factors are; age less than 12 months, non-ambulatory status, delayed presentation, inconsistent mechanism of injury and presence of any other injury. The aim of this study was to study the pattern of fractures seen in children and to determine if physicians are taking the necessary history required to rule out a diagnosis of NAI. Method A 13 month retrospective analysis of medical records was carried out for all children aged less than 3 presenting to the ED department from January 2012–January 2013. The cases were found through clinical coding and fracture clinic. Results A total of 106 children were identified during the time period; there was an even distribution of males and females. Documentation was universally lacking; developmental stage of child and mobility was not documented in 80 cases (75%) and whether injury was witnessed was not documented in 22 cases (20%). 25 (23%) of cases had a delayed presentation, 4 (3.5%) had an un-witnessed event and 9 (8%) had no mechanism of injury, only 1 of these cases were discussed with Paediatrics. There were 3 children aged <1; 1 skull, 1 clavicle and 1 femoral fracture. 2/3 cases were discussed with Paediatrics. Number of risk factors Number of cases Action taken? 1 27 4/27 2 14 6/14 3 3 1/3 4 2 1/2 Overall, only 2 (1%) cases were discussed with paediatrics, 1 with social services and 17 (17%) discussed with senior ED doctors. Conclusion There is a lack of recognition for the risk factors of abuse and therefore opportunities for discussions about NAI are missed. There is also inadequate history and examination of additional injuries required to rule out non-accidental injury. This warrants a significant change to the training of ED staff in safeguarding to ensure that children presenting with NAI are not missed.