Skeletal surveys in children with burns caused by child abuse

Objective: To determine the frequency of occult fractures in children with suspicious burns compared with children with other types of physical abuse. Methods: Child abuse outpatient clinic reports and inpatient consultations from a midwest urban children's hospital for 1989 to 2000 were reviewed. Demographic and clinical data were abstracted for patients seen because of suspected physical abuse. Patients were classified based on reason seen (burns vs other physical injuries), whether they were diagnosed as abused, and whether they had at least I skeletal survey. Positive skeletal surveys were defined as having a fracture that was unexplained, highly specific for abuse, or with a perpetrator confession. Results: Of 335 patients evaluated, the mean age (+/- SD) was 1.5 +/- 1.9 years, 63% were boys, 64% were white, and 80% had skeletal surveys performed. Reasons for evaluation included 69 (21%) for burns and 266 (79%) for other injuries. After excluding patients without a final diagnosis of abuse and those presenting with obvious fractures, 5 (14%) of 36 burn patients had positive skeletal surveys compared with 45 (34%) of 133 with nonburn injuries (P = 0.02). Burn patients were older compared with those with nonburn injuries (mean ages, 1.8 +/- 1.5 vs. 1.1 +/- 1.6 years; P = 0.03) and were more likely to be nonwhite (69% vs. 32%; P < 0.001). Conclusions: Although young children with abusive burns have fewer occult fractures compared with those with other abusive injuries, the frequency of occult fractures is still high enough to warrant the consideration of skeletal surveys in these cases.