Background Recognition of child physical abuse (PA) is important to avoid further morbidity and mortality. There is limited knowledge regarding how frequently paediatric emergency department (PED) clinicians consider child abuse in infants with fractures.

Objective Estimate the percentage of infants with fractures for whom PA was considered, and to examine characteristics that are associated with consideration of PA.

Methods We reviewed the electronic medical record (EMR) of all patients ≤ 1 year with fractures in a PED between 2008–2012. We used a multivariable logistic regression model to examine associations of patient and physician characteristics with our primary outcome variable, consideration of PA, defined as clearly-documented consideration of PA in attending or trainee note OR skeletal survey ordered OR child-abuse team consult ordered. Co-variates examined as well.

Results Characteristics of 529 patients and physicians are displayed in Table 1. For the entire cohort, consideration of PA occurred in 346 (65%), whereas consideration in infants <6 months of age occurred in 194 (78%). EMR clearly-documented consideration of PA occurred in 288 (54%). Characteristics associated with greater odds for consideration of PA after covariate adjustment (OR and 95% CI) included younger patient age (IQR of 12.1 to 38.7 weeks: 0.53 [0.33, 0.84]), no history provided for injury (9.41 [3.88, 22.82]), soft-tissue injury (4.95, [1.57, 15.54]), and male attending (1.84, [1.12, 3.01]).

Conclusion PED physicians frequently do not consider PA in infants with fractures. Characteristics associated with consideration for PA include patient age, no history provided to explain the injury, soft-tissue injury, and male attending gender.