Skeletal Survey of Children Younger Than 1 Year With Fractures: A Cross-sectional Study (2017-2023).

Abstract

Fractures in infants younger than 1 year without an obvious accidental cause raise suspicion of child abuse, warranting a skeletal survey. However, adherence to child abuse screening guidelines remains suboptimal. This study aimed to identify factors associated with skeletal survey completion in infants with fractures in the absence of a clear accidental context. A retrospective chart review was conducted on children younger than 1 year with at least one fracture, identified over a 6-year period (2017-2023) at a French tertiary children's hospital. Infants with fractures due to obstetric trauma or road traffic accidents were excluded. Multivariate logistic regression was used to determine factors associated with skeletal survey completion. A total of 312 children were included, of whom 97 (33%) underwent a skeletal survey. Among those children, additional fractures were detected in 16 (16.5%). Skeletal surveys were more frequently performed in boys (odds ratio [OR]: 3.82, 95% confidence interval [CI]: 1.66-8.84), younger infants, and those with an inconsistent or evolving trauma explanation (OR: 17.18, 95% CI: 1.86-158.26) or no reported explanation (OR: 16.56, 95% CI: 6.30-43.54). Only one-third of infants were screened for occult fractures, but the factors associated with skeletal survey completion aligned with established clinical guidelines. Long-term follow-up is necessary to assess whether the two-thirds of children who were unscreened were later identified as victims of child abuse.