Abusive fracture incidence over three decades at a level 1 pediatric trauma center

Few studies have examined the incidence of abusive fractures in children. Only one study to date, from a single pediatric trauma center,has reported on the incidence of abusive fractures over time. That study showed a decrease in abusive fractures over a 24-year period. Our objective for this current study was to compare these published data with recent data from this same trauma center, allowing for a detailed comparison of the incidence of abusive fractures over a 30-year period. We included children < 36 months of age who presented to the emergency department of a level 1 pediatric trauma center (2007–2010) with ≥ 1 fracture. Six experts from 3 different fields rated each case on the likelihood the fracture(s) was caused by abuse using an established 7- point scale, and a consensus rating was agreed upon for each case. The incidence of abusive fractures was calculated per 10,000 children < 36 months of age living in the geographic region and per 10,000 ED visits and was compared to previously published data for three prior time periods (1979–1983, 1991–1994, and 1999–2002) at the same pediatric trauma center. From 2007–2010, 551 children were identified, including 31 children who were rated as abused. The incidence of a child presenting with an abusive fracture in the county per year was 2.7/10,000 children <36 months of age. The previous three time periods showed a countywide incidence of 3.2/10,000 (1979–1983), 1.7/10,000 (1991–1994), and 2.0/10,000 (1999–2002) (p for trend 0.34). The incidence per ED visit was 2.5/10,000 in the recent time period compared to 6.0/10,000 (1979–1983), 3.4/10,000 (1991–1994), and 2.5/10,000 (1999–2002) (p for trend < 0.001). In this single institution review of fractures in children < 36 months of age, the incidence of abusive fractures has remained relatively constant over a 30-year period.