Non-Accidental Injury

Question 1

What % of fractures in children <1 y/o are due to non-accidental injury?

1 - 5%
2 - 25%
3 - 50%
4 - 75%

Answer 1

3 - 50%

• 2nd most common cause of death in children

Question 2

90% of fractures are due to abuse in children under what age?

1 - <1 y/o
2 - <5 y/o
3 - <10 y/o
4 - <15 y/o

Answer 2

2 - <5 y/o

• if underreported there is a 30-50% change of further abuse
• 5-10% change of death from abuse

Question 3

Is abuse in children only physical?

Answer 3

• no

Can be:
- physical
- sexual
- psychological
- emotional
- verbal
- financial
- encompasses coercive control.

Question 4

Excessive crying in infants (0-4 months) is most likely to be a sign of what?

1 - hungry baby
2 - excessive shaking
3 - mardy baby
4 - sick baby

Answer 4

2 - excessive shaking
- all are possible though

Excessive crying in 0-4 months has a higher risk of non-accidental harm

Question 5

When looking at bruises on a child, which of the following is least important?

1 - shape of bruises (hand marks)
2 - pattern of bruises (non-boney locations or face/ears)
3 - multiple or cluster of bruises
4 - age of bruises
5 - colour of bruises
6 - bruises in children who cannot mobilise

Answer 5

5 - colour of bruises
- all the others are more important

Question 6

In addition to bruises, which of the following should we be concerned about?

1 - human like bite marks
2 - thermal injuries
3 - lacerations/abrasions
4 - fractures
5 - intracranial injuries
6 - all of the above

Answer 6

6 - all of the above

Question 7

What is the name the the categories used to identify the type of fracture at the growth plates in a child?

1 - modified glasgow scale
2 - salter-harris scale
3 - CURB scale
4 - WELLS scale

Answer 7

2 - salter-harris scale

Question 8

What is a torus fracture in paediatrics?

1 - involves only one cortex of bone
2 - involves both cortices but one is still intact
3 - bone bends and is deformed like a plastic bone

Answer 8

1 - involves only one cortex of bone

• cortex refers to the hard outer layer of bones

Question 9

What is a greenstick fracture in paediatrics?

1 - involves only one cortex of bone
2 - involves both cortices but one is still intact
3 - bone bends and is deformed like a plastic bone

Answer 9

2 - involves both cortices but one is still intact

Question 10

What is a plastic deformation fracture in paediatrics?

1 - involves only one cortex of bone
2 - involves both cortices but one is still intact
3 - bone bends and is deformed like a plastic bone

Answer 10

3 - bone bends and is deformed like a plastic bone

Question 11

All of the following fractures can occur through non-accidental injury, but which is the most common?

1 - humerus
2 - tibia
3 - femur
4 - ribs

Answer 11

1 - humerus

Question 12

If we suspect a safeguasrding issue, who should we get involved in the care and management of a child?

1 - senior nurse on department
2 - crash team
3 - pediatric and safeguarding team
4 - consultant on call

Answer 12

3 - pediatric and safeguarding team

Question 13

Are upper of lower limb fractures more common?

Answer 13

• upper limbs
• distal radius and ulna are most common

Question 14

What are 2 of the most common causes of upper limb injury from the list below:

1 - fall on outstretched hand (FOOSH)
2 - impact trauma
3 - direct injury (punch)
4 - infection

Answer 14

1 - fall on outstretched hand (FOOSH)
3 - direct injury (punch)

Question 15

In children who may present with regular bruising, hearing loss and a history of multiple fractures that is not due to a non-accidental injury, which 2 of the following differentials are most likely?

1 - osteoperosis
2 - coagulopathy disorder
3 - rickets disease
4 - osteogenesis Imperfecta

Answer 15

2 - coagulopathy disorder
- accounts for easy bruising

4 - osteogenesis Imperfecta
- genetic disorder causing hearing loss and multiple fractures