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Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. 599-604 (doi:10.1542/peds.2007-1959)
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ARTICLE

Incidence of Fractures Attributable to Abuse in Young Hospitalized Children: Results From Analysis of a United States Database

John M. Leventhal, MDa, Kimberly D. Martin, MPhilb, Andrea G. Asnes, MD, MSWa

Departments of a Pediatrics
b Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut

OBJECTIVE. The goal was to assess the proportion of children with fractures attributable to abuse and the incidence of fractures caused by abuse among children <36 months of age who were hospitalized in the United States.

METHODS. We used the Kids' Inpatient Database, which has discharge data on 80% of acute pediatric hospitalizations in the United States, for 3 time periods (1997, 2000, and 2003). Fractures attributable to abuse in children <36 months of age were identified by both an International Classification of Diseases, Ninth Revision, Clinical Modification code for fracture and a diagnosis external-cause-of-injury code for abuse. Weighted estimates of the incidence were calculated.

RESULTS. Among children <36 months of age who were hospitalized with fractures, the proportions of cases attributable to abuse were 11.9% in 1997, 11.9% in 2000, and 12.1% in 2003. The proportions of cases attributable to abuse decreased with increasing age; for example, in 2003, the proportions attributable to abuse were 24.9% for children <12 months of age, 7.2% for children 12 to 23 months of age, and 2.9% for children 24 to 35 months of age. In 2003, the incidence of fractures caused by abuse was 15.3 cases per 100000 children <36 months of age. The incidence was 36.1 cases per 100000 among children <12 months of age; this decreased to 4.8 cases per 100000 among 12- to 23-month-old children and 4.8 cases per 100000 among 24- to 35-month-old children.

CONCLUSIONS. The Kids' Inpatient Database can be used to provide reasonable estimates of the incidence of hospitalization with fractures attributable to child abuse. For children <12 months of age, the incidence was 36.1 cases per 100000, a rate similar to that of inflicted traumatic brain injury (25–32 cases per 100000).

Key Words: fracture • incidence • abuse

Abbreviations: CI—confidence interval • TBI—traumatic brain injury • KID—Kids' Inpatient Database • E-code—external-cause-of-injury code • ICD-9-CM—International Classification of Diseases, Ninth Revision, Clinical Modification

Accepted Dec 12, 2007.


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