“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, MD, an associate professor of orthopedic surgery and chief of the division of pediatric orthopedics at Rutgers New Jersey Medical School, in a press release.
Dr. Chu and colleagues queried the New York Statewide Planning and Research Cooperative System administrative database for data spanning 2004 through 2013 on children aged 0 to 12 years presenting in the emergency department or ambulatory surgery center with fingertip injuries—including amputation, avulsion, or crushed finger—and abuse. The relationship between fingertip injuries and child abuse was evaluated with consideration for factors including insurance status, race, ethnicity, sex, and behavioral risks (depression, attention-deficit hyperactivity disorder, aggressive behavior, and autism).
Fingertip Injuries and Abuse: Pattern Observed
A total of 4,870,299 presented during the study period, of whom 79,108 (1.62%) had fingertip injuries. Among the patients with fingertip injuries, 0.27% (n=216) presented, with an International Classification of Diseases, Ninth Revision diagnosis code for child abuse at that visit or in a different visit; the rate of presenting with a child abuse code among the non-fingertip injury patients was 0.22% (n=10,483). An adjusted analysis revealed that the likelihood of sustaining a fingertip injury in children who had been abused, compared to those who had not, was 23% higher (odds ratio [OR]=1.23; 95% confidence interval [CI], 1.07–1.41). Fingertip injuries were also more likely to occur in children who 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).
“There is no one injury type that is 100 percent 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,” according to Dr. Chu.
“Currently, pediatric 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 added. “Doctors need to see these instances as a possible injury from abuse or neglect so they can be on higher alert during the evaluation.”