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Table 5 Association of History & Examination Characteristics with Likelihood of Abuse

From: Prevalence of abuse among young children with femur fractures: a systematic review

Characteristics

Study

Sensitivity (95%CI)

Specificity (95%CI)

LR+ (95% CI)

LR- (95% CI)

p a

Reported History of Trauma c

      

     Suspicious vs. non-suspicious

Blakemore, 1996

68.7 (46.0-91.5)

88.0 (75.3-100.0)

5.7 (1.9-17.4)

0.4 (0.2-0.7)

<0.001

     Suspicious vs. non-suspicious

Baldwin, 2011

32.9 (21.9-43.9)

95.7 (92.3-99.1)

7.6 (3.2-17.8)

0.7 (0.6-0.8)

<0.001

     Suspicious vs. non-suspicious

Hui, 2008

71.4 (47.8-95.1)

97.3 (94.4-100.0)

26.9 (8.4-86.2)

0.3 (0.1-0.7)

<0.001

     Unknown vs. known history

Shrader, 2011

39.5 (24.9-54.1)

94.7 (90.1-99.2)

7.4 (2.9-18.8)

0.6 (0.5-0.8)

<0.001

     Unwitnessed vs. witnessed

Blakemore, 1996

43.8 (19.4-68.1)

72.0 (54.4 -89.6)

1.6 (0.7-3.6)

0.8 (0.5-1.3)

0.33

     Witnessed by non-parent (yes vs. no)

Blakemore, 1996

18.8 (0.0-37.9)

48.0 (28.4-67.6)

0.4 (0.1-1.1)

1.7 (1.1-2.7)

0.05

     History of fall vs. other history

Blakemore, 1996

93.8 (81.9-100.0)

26.9 (9.9-44.0)

1.3(1.0-1.7)

0.2 (0.0-1.7)

0.13

Reported time from injury to care

      

     Delay >24 hours vs. no delay

Hui, 2008

42.9 (16.9-68.8)

92.0 (87.0-97.0)

5.4 (2.3-12.9)

0.6 (0.4-1.0)

0.002

Location Injury Occurred

      

Home/unknown vs. public placed

Rewers, 2005

97.9 (93.9-100)

22.5 (17.65-27.4)

1.2-1.4

0.1 (0.0-0.7)

<0.001

Additional Injuries

      

     Fractures, bruises, or SDHs (yes vs. no)

Hui, 2008

42.9 (16.9-68.8)

92.0 (87.0-97.0)

3.7 (1.7-8.2)

0.6 (0.4-1.0)

0.007

     Bruises vs. no bruises

Pierce, 2005

100 (NAe)

72.0 (NAe)

3.6 (1.9-6.7)

0.0 (NA)

0.01 b

     Current polytraumae (yes vs. no)

Baldwin, 2011

52.9 (41.2-64.6)

92.1 (87.6-96.6)

6.7 (3.6-12.3)

0.5 (0.4-0.7)

<0.001

     Occult injury on imaging (yes vs. no)

Pierce, 2005

75.0 (19.4-99.4)

100.0 (86.0-100.0)

NA

0.3(0.0-1.4)

0.001

     Any

Shrader, 2011

20.9 (8.8-33.1)

90.4 (84.5-96.4)

2.2 (0.9-5.1)

0.9 (0.7-1.0)

0.10

  1. aComputed using two-sided Fisher’s exact test. P-values of 0.05 or less were considered statistically significant and are presented in bold text.
  2. b P-value reported in Pierce [31] was 0.055 but computed as 0.010 using two-sided Fisher’s exact test.
  3. cDefinition of suspicious history generally included no known history of trauma, or a history of trauma that was unwitnessed or considered inconsistent with the injury.
  4. dPublic place included locations categorized as public, recreation, and street.
  5. eCurrent polytrauma was defined as another concurrent long bone, clavicle, axial fracture, or other body system injury that would require hospitalization.
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BMC Pediatrics

ISSN: 1471-2431

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