A study is the first to look at the link between children's fingertip injures and abuse or neglect. The researchers used a New York state database that tracks medical discharge records to identify 79,108 children from infancy to 12 years old who sought emergency treatment between 2004 and 2013 for fingertip injuries, such as amputation, tissue damage or crushing, from a total of 4,870,299 children in the database. They then analysed the children's medical record history for documentation of abuse.
"We found that children who had been coded at some point with physical abuse were more likely to have also been brought in for treatment of a fingertip injury," said lead author Alice Chu, an associate professor of orthopaedic surgery and chief of the division of paediatric orthopaedics at Rutgers New Jersey Medical School.
Fingertips injuries can occur during abuse when a child is treated roughly or when the abuser slams a door or steps on their hands. "There is no one injury type that is 100% predictive of child abuse, but all the small risk factors can add up. Since fingertip injuries are mostly inflicted by someone else – whether intentional or accidental – it should be a signal to physicians to look deeper into the child's medical history for signs of neglect or physical abuse," said Chu.
Doctors may suspect abuse if parents provide a vague history with contradictory statements, if they delay seeking treatment or if the child's developmental stage is inconsistent with the type of injury, she noted.
"Currently, paediatric fingertip injuries typically are not considered an injury of abuse but one of accidental trauma or a clumsy child who gets his finger caught in a door," she said. "Doctors need to see these instances as a possible injury from abuse or neglect so they can be on higher alert during the evaluation."
Abstract
Purpose: Pediatric fingertip injuries are most commonly reported in the setting of an accidental occurrence. The purpose of this study was to determine whether there is an association of child abuse and neglect with pediatric fingertip injuries.
Methods: The New York Statewide Planning and Research Cooperative System (2004 to 2013) administrative database was used to identify children aged 0 to 12 years who presented in the inpatient or outpatient (emergency department or ambulatory surgery) setting. International Classification of Diseases, Ninth Revision diagnosis codes were used to identify fingertip injuries (amputation, avulsion, or crushed finger) and abuse. Cohort demographics of children presenting with fingertip injuries were described. We analyzed the association between fingertip injuries and child abuse using multivariable logistic regression, with variables for insurance status, race, ethnicity, sex, and behavioral risks including depression, attention-deficit hyperactivity disorder, aggressive behavior, and autism.
Results: Of the 4,870,299 children aged 0 to 12 years in the cohort, 79,108 patients (1.62%) during the study period (2004 to 2013) presented with fingertip injuries. Of those with a fingertip injury, 0.27% (n = 216) presented either at that visit or in other visits with a code for child abuse, compared with 0.22% of pediatric patients without a fingertip injury (n = 10,483). In an adjusted analysis, the odds of a fingertip injury were 23% higher (odds ratio [OR] = 1.23; 95% confidence interval [CI], 1.07–1.41) for children who had been abused, compared with those who had not. Patients were more likely to present with fingertip injuries if they had ever had Medicaid insurance (OR = 1.40; 95% CI, 1.37–1.42) or had a behavioral risk factor (OR = 1.35; 95% CI, 1.30–1.40).
Conclusions: Patients presenting with abuse are significantly more likely to have fingertip injuries during childhood compared with those without recorded abuse, which suggests that these injuries may be ones of abuse or neglect. Medicaid insurance, white race, and behavioral diagnoses of depression, attention-deficit hyperactivity disorder, aggressive behavior, and autism were also associated with increased odds of presenting with fingertip injuries.
Authors
Christopher S Klifto, Jessica A Lavery, Heather T Gold, Michael T Milone, Raj Karia, Vincent Palusci, Alice Chu
[link url="https://news.rutgers.edu/research-news/children%E2%80%99s-fingertip-injuries-could-signal-abuse/20200212#.XkQRd1JKi4S"]Rutgers University material[/link]
[link url="https://www.jhsgo.org/article/S2589-5141(19)30106-9/fulltext"]Journal of Hand Surgery Global Online abstract[/link]