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lüll Delayed identification of pediatric abuse-related fractures Ravichandiran N; Schuh S; Bejuk M; Al-Harthy N; Shouldice M; Au H; Boutis KPediatrics 2010[Jan]; 125 (1): 60-6OBJECTIVES: Because physicians may have difficulty distinguishing accidental fractures from those that are caused by abuse, abusive fractures may be at risk for delayed recognition; therefore, the primary objective of this study was to determine how frequently abusive fractures were missed by physicians during previous examinations. A secondary objective was to determine clinical predictors that are associated with unrecognized abuse. METHODS: Children who were younger than 3 years and presented to a large academic children's hospital from January 1993 to December 2007 and received a diagnosis of abusive fractures by a multidisciplinary child protective team were included in this retrospective review. The main outcome measures included the proportion of children who had abusive fractures and had at least 1 previous physician visit with diagnosis of abuse not identified and predictors that were independently associated with missed abuse. RESULTS: Of 258 patients with abusive fractures, 54 (20.9%) had at least 1 previous physician visit at which abuse was missed. The median time to correct diagnosis from the first visit was 8 days (minimum: 1; maximum: 160). Independent predictors of missed abuse were male gender, extremity versus axially located fracture, and presentation to a primary care setting versus pediatric emergency department or to a general versus pediatric emergency department. CONCLUSIONS: One fifth of children with abuse-related fractures are missed during the initial medical visit. In particular, boys who present to a primary care or a general emergency department setting with an extremity fracture are at a particularly high risk for delayed diagnosis.|Accidental Falls/*statistics & numerical data[MESH]|Age Factors[MESH]|Child Abuse/*diagnosis/statistics & numerical data[MESH]|Child, Preschool[MESH]|Confidence Intervals[MESH]|Delayed Diagnosis/*statistics & numerical data[MESH]|Diagnosis, Differential[MESH]|Emergency Service, Hospital[MESH]|Female[MESH]|Fractures, Bone/*diagnosis/epidemiology/etiology[MESH]|Humans[MESH]|Incidence[MESH]|Infant[MESH]|Infant, Newborn[MESH]|Injury Severity Score[MESH]|Male[MESH]|Mandatory Reporting[MESH]|Needs Assessment[MESH]|Odds Ratio[MESH]|Ontario[MESH]|Physical Examination/methods[MESH]|Probability[MESH]|Retrospective Studies[MESH]|Risk Assessment[MESH]|Sex Factors[MESH] |