Are Abusive Fractures in Young Children Becoming Less Common?: Changes over 24 Years

Autor/inn/en	Leventhal, John M.; Larson, Ilse A.; Abdoo, Denise; Singaracharlu, Sujatha; Takizawa, Carolina; Miller, Cindy; Goodman, T. R.; Schwartz, Dana; Grasso, Susanne; Ellingson, Katherine
Titel	Are Abusive Fractures in Young Children Becoming Less Common?: Changes over 24 Years
Quelle	In: Child Abuse & Neglect: The International Journal, 31 (2007) 3, S.311-322 (12 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	0145-2134
DOI	10.1016/j.chiabu.2006.07.004
Schlagwörter	Injuries; Young Children; Child Abuse; Incidence + Suchen Sie Ihr Suchwort? Frühe Kindheit; Abuse of children; Abuse; Child; Children; Kindesmissbrauch; Missbrauch; Kind; Kinder; Vorkommen
Abstract	Objective: To determine whether the proportion of fractures rated as abusive in children less than 36 months of age evaluated at a regional pediatric hospital increased over a 24-year period from 1979 to 2002. Fractures were chosen as an example of serious injuries in young children. Methods: Medical records were abstracted for all children less than 36 months of age who were seen at a single pediatric hospital with a fracture during three time periods: 1979-1983, 1991-1994, and 1999-2002. After reviewing the abstracted and radiographic information, two clinicians (one an expert on child abuse) and two pediatric radiologists each rated the likelihood of abuse using explicit criteria and a seven-point scale from definite abuse to definite unintentional injury. Ratings were done independently; when disagreements occurred, the case was discussed, and a joint rating was agreed upon, if possible. The proportions of cases rated as abuse were compared over the three time periods, and logistic regression was used to calculate adjusted odds ratios (OR). Results: In the early, middle, and late samples, there were 200, 240, and 232 children, respectively, with fractures. The proportion of cases rated as abuse decreased from 22.5% in the early period to 10.0% in the middle period and was 10.8% in the late period (p less than 0.001). When comparing the odds of abuse in the middle and late groups to the odds of abuse in the early group (controlling for age, gender, ethnicity, type of medical insurance, and site of pediatric care), the adjusted ORs were 0.31 (95% CI = 0.15, 0.62) for the middle group and 0.45 (95% CI = 0.23, 0.86) for the late group. Thus, the odds of a given case being rated as abuse decreased by over 50% from the early period to the middle and late time periods. No statistically significant difference was found when comparing the odds of abuse for the middle group to those of the late group, OR: 1.46 (95% CI = 0.69, 3.08). Conclusions: The proportion of abusive fractures in young children decreased substantially from 1979-1983 to 1991-1994 and 1999-2002 at a major pediatric hospital. We speculate that this decrease may reflect early recognition of less serious forms of maltreatment and the availability of services to high-risk families. (Author).
Anmerkungen	Elsevier. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Tel: 877-839-7126; Tel: 407-345-4020; Fax: 407-363-1354; e-mail: usjcs@elsevier.com; Web site: http://www.elsevier.com
Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2017/4/10