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Study identifies patterns in abuse

By Amos Esty

One-third of all child-abuse victims will see an orthopaedist sometime during childhood for abuse-related injuries. As a result, says Daniel Bullock, M.D., it's important for orthopaedists such as himself to be able to recognize cases of abuse. While he was a resident at DHMC, Bullock led a study comparing injuries caused by child abuse to injuries resulting from other factors. The results, published in the Journal of Pediatric Orthopaedics, offer insight for orthopaedists into the difficult task of determining the likelihood that an injury was caused by abuse.

Injuries on weekdays were more likely to be the result
of abuse.

Visits: Working with several members of the Department of Orthopaedics, Bullock examined data from a nationwide inpatient sample of cases of physical injury in children younger than 18. Of the more than 650,000 hospital visits during the years Bullock studied, 11,554 were determined to have been caused by child abuse. To tease out any relevant differences between injuries related and not related to abuse, Bullock looked at factors such as demographic characteristics, the timing of the visit, and the type of injury.

The strongest findings related to the age of the child. More than half (57%) of the cases that involved abuse were in children under the age of one. Children between one and two years old had the next highest likelihood of an injury being related to abuse, with 13% of the cases falling in that age range. Bullock says these findings were not especially surprising, given previous research on the topic.

More surprising was the fact that injuries that occurred on weekdays were more likely to be the result of abuse. It's possible, Bullock surmises, that parents or other caregivers might be under more stress during the workweek than on weekends.

There was also a seasonal difference. Injuries suffered in winter were more likely to be the result of abuse than injuries in other seasons, though winter did not have the highest raw number of abuse cases. One possible explanation of this finding, Bullock says, is that "in the summer, children are out and about, playing in circumstances where they're likely to fall in a non-child abuse circumstance. Whereas in the winter, particularly in northern climates, that opportunity is less available."

Payment: Another finding was related to payment. Cases in which Medicaid was the payer were about twice as likely to involve abuse as were cases involving any other payer.

Now an orthopaedic surgery sports medicine fellow in Aspen, Colo., Bullock hopes his research will help orthopaedists when they encounter possible cases of abuse. "It is something that orthopaedists are taught to try and recognize, but there are so many gray areas that it remains difficult," he says. He notes that his findings are not meant as definitive guidelines, but as "one more component to help either lower or raise someone's suspicion of child abuse."

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