背景:患有孤立性股骨干骨折的儿科患者很难评估非意外创伤(NAT)。这项研究的目的是确定(1)是否存在与可疑NAT相关的孤立性股骨干骨折的人口统计学特征,以及(2)是否存在与可疑NAT相关的孤立性股骨干骨折相关的临床体征。
方法:对2010年1月至2018年6月所有股骨干骨折患者进行回顾性分析。我们纳入了年龄小于4岁的孤立性股骨干骨折患者。我们排除了4岁及以上的患者,多发性创伤,机动车碰撞,和骨生物学改变的患者。可疑NAT的诊断是通过审查记录的社会工作评估来确定的。我们记录了骨折特征,包括沿股骨的位置以及骨折模式和NAT检查中相关发现的存在,包括视网膜出血的存在。硬膜下血肿,先前骨折的证据,或皮肤病变。灵敏度,特异性,阳性预测值(PPV),并计算这些相关结果的阴性预测值(NPV)。
结果:完全,144例患者符合纳入标准。对50名患者(35%)进行了社会工作咨询。在27例患者(19%)中诊断出可疑NAT。非NAT患者的平均年龄为0.82岁和2.25岁(P<0.01)。检查中出现的皮肤病变的发生率和类型在两组之间没有差异。疑似NAT的患者没有发现视网膜出血或硬膜下血肿,但27例患者中有5例(19%)在骨骼检查中有先前骨折的证据。视网膜出血的敏感性,硬膜下,骨骼调查为0%,0%,和19%,所有的特异性都是100%。NPV为39%,27%,63%,分别。骨骼调查的PPV为100%。由于本研究中没有患者出现视网膜出血或硬膜下血肿阳性,无法评估这些患者的PPV.
结论:在当前的研究中,NAT的迹象,如皮肤损伤,视网膜出血,硬膜下血肿,骨骼检查中先前骨折的证据可能对诊断孤立性股骨干骨折患者的可疑NAT没有帮助。
方法:III级诊断研究。
BACKGROUND: Pediatric patients with isolated femoral diaphyseal fractures are difficult to assess for nonaccidental trauma (NAT). The purpose of this study was to determine (1) if there are any demographic features of isolated femoral diaphyseal fractures associated with suspected NAT and (2) if there are clinical signs associated with isolated femoral diaphyseal fractures associated with suspected NAT.
METHODS: All patients with femoral diaphyseal fractures from January 2010 to June 2018 were reviewed. We included patients younger than 4 years old with isolated femoral diaphyseal fractures. We excluded patients 4 years old and older, polytraumas, motor vehicle collisions, and patients with altered bone biology. Diagnosis of suspected NAT was determined by review of a documented social work assessment. We recorded fracture characteristics including location along femur as well as fracture pattern and presence of associated findings on NAT workup including the presence of retinal hemorrhage, subdural hematoma, evidence of prior fracture, or cutaneous lesions. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these associated findings were calculated.
RESULTS: Totally, 144 patients met the inclusion criteria. Social work was consulted on 50 patients (35%). Suspected NAT was diagnosed in 27 patients (19%). The average age of patients with suspected NAT was 0.82 and 2.25 years in patients without NAT ( P <0.01). The rate and type of skin lesions present on exam were not different between the 2 groups. Patients with suspected NAT had no findings of retinal hemorrhage or subdural hematoma, but 5 of 27 patients (19%) had evidence of prior fracture on skeletal survey. The sensitivities of retinal hemorrhage, subdural, and skeletal survey were 0%, 0%, and 19% and the specificities of all were 100%. The NPVs were 39%, 27%, and 63%, respectively. The PPV of skeletal survey was 100%. Since there were no patients in this study with positive findings of retinal hemorrhage or subdural hematoma, the PPV for these could not be assessed.
CONCLUSIONS: In the current study, signs of NAT such as skin lesions, retinal hemorrhage, subdural hematoma, and evidence of prior fracture on skeletal survey may not be helpful to diagnosis suspected NAT in patients with an isolated femoral diaphyseal fracture.
METHODS: Level III-diagnostic study.