A 2 year retrospective analysis was carried out of our ED and hospital notes from 2007 to 2008, of all children under the age of 24 months who presented with a fracture of any description to the ED. The study looked at the patients age (months) and gender, the site and type of fracture, whether the patient was hospitalised or discharged from the ED, if any concern was reported or a child protection referral was made, and also the area of the city the child was from.
In 2007-2008 there was an incidence of 53 fractures per 10,000 children less than 2 years. The proportion increased with age with femur and skull fractures found in the youngest age category being associated with a referral to the child protection services. An unclear history regarding mechanism of injury was also noted in a high proportion of referrals. In 34%of patients the time interval was not recorded, a crucial risk factor in NAI.
Age is a strong determinant when accessing NAI and a non-ambulant child presenting with a femur or skull fracture should be regarded highly suspicious of NAI. The time interval between the injury and presentation to the ED must be recorded in all notes when assessing a child for NAI.