Identification of Potential Abuse in Young Children with a Hand Fracture

Purpose: Identifying child abuse in young children, especially through hand fractures, presents a significant challenge for healthcare providers. This study aimed to explore the socio-demographic and medical characteristics associated with child abuse in children under five who presented with hand fractures at a pediatric emergency department in north-central Israel from 2018 to 2023. Methods: This retrospective study analyzed data from 828 children who presented with hand fractures. Key factors, such as nationality, history of previous fractures, and recent hospitalizations, were examined for their association with child abuse. Statistical analyses, including logistic regression, were performed to determine associations and significance. Results: The study identified 30 (3.6%) victims of abuse among the cohort. Significant factors associated with a higher likelihood of abuse included Arab nationality (OR 2.4; 95% CI 1.01–5.93), prior fracture history (OR 1.9; 95% CI 1.20–2.99), and hospitalization within the past year (OR 3.1; 95% CI 1.31–7.46), all with p-values < 0.01. Victims of abuse had more previous fractures (M = 0.93) and more hospitalizations in the previous year (M = 1.13) compared to non-victims. In the reviewed cases classified as abuse, documentation indicated the father as the alleged perpetrator in each instance. Conclusions: These findings highlight the critical role of healthcare providers in recognizing and reporting potential child abuse, particularly in cases of recurrent injuries and frequent hospital visits. Understanding these risk factors can help in early identification and protection of at-risk children. Further research is needed to enhance protective measures and gain deeper insights into the factors influencing the identification of child abuse.