While reading an orthopaedic text you find a table that states rib fractures are highly specific for non-accidental injury in children. No papers are referenced and you wonder what evidence exists to support this statement.

Structured clinical question

In children undergoing chest radiography [patients] are rib fractures on plain radiographs [test] specific for non-accidental injury [outcome]?

Search strategy and outcome

Secondary sources

Cochrane: rib fractures and non-accidental injury; no relevant reviews found.

Primary sources

Medline (including Medline corrections) 1966–01/02/2004. [(Validated paediatric search filter (March 2003) for Ovid¹) AND (exp Child Abuse or non-accidental injury.mp or child abuse$.mp or deliberate injury.mp or exp. domestic violence or child abuse, sexual or exp. Munchausen syndrome by proxy or exp torture or domestic violence.mp or Munchausen syndrome by proxy.mp. or torture.mp or non-accidental injuries.mp) and (exp.rib fractures or rib fracture$.mp or posterior rib fracture$.mp or multiple rib fracture$.mp or bilateral rib fracture$.mp or exp. thoracic injuries or thoracic injury.mp or chostochondral junction injuries.mp)] limited to human and English Language.

A total of 113 papers were identified; 105 were of insufficient quality for inclusion or irrelevant. One paper was subsequently excluded …