Transcript Fractures in children under 3 years of age

Dr E Payne, Dr H Murch & Dr C Woolley
Ysbyty Ystrad Fawr Hospital,
Aneurin Bevan University Health Board
Concerning features
(RCPCH Child Protection Companion 2008)

Age

Doesn’t fit the injury

Doesn’t fit with development

Inconsistent history

Unwitnessed

Inappropriate parental response

Repeated attendance

Known to social services
Types of fracture suspicious of abuse
(RCPCH Child Protection Companion 2008)

Multiple fractures

Humeral

Rib fractures

Femoral fractures (non-mobile child)

Spinal fractures

Metaphyseal fractures

Skull fracture.
Audit aims

To study fractures seen in children under
3yrs in A&E during 2012-13.

To evaluate the documentation &
assessment as recommended by
RCPCH Child Protection Companion
2008.
Method

Retrospective analysis of medical
records for children under 3 years with
fracture presenting to A&E in two Gwent
hospitals.

N = 106
Age distribution
30
Number of cases
25
20
15
10
5
0
0-0.5 yrs
N=106
F 54, M 52.
0.5-1 yrs
1-1.5 yrs
1.5-2 yrs
2-2.5 yrs
2.5-3 yrs
Site of fracture
35
Number of cases
30
25
20
15
10
5
0
Risk factors for NAI

No mechanism of injury 8.5%

Delay in presentation 23%

Unwitnessed injury 3.5%
Action

6/32 discussed when 1 risk factor

2/9 discussed when 2 risk factors

0/1 discussed when 3 risk factors

1/2 discussed when 4 risk factors
Conclusions

Adherence to departmental guidelines in
2/3 cases.

Lack of recognition of risk factors for NAI.

Very few referrals to paediatrics & social
services.

Opportunities for discussions about NAI
are missed.
Intervention

Mandatory training in Child Protection
(e-LFH) for A&E juniors.

A&E triggers:
 A&E database to include red flags for NAI.
 Paediatric nurse triaging to discuss with A&E
senior.