Risk Factors for Long-bone Fractures in Young Children
Risk Factors for Long-bone Fractures in Young Children
Aim To investigate risk factors for first long-bone fractures in children up to 5 years old in order to provide evidence about which families could benefit from injury prevention interventions.
Methods Population-based matched nested case–control study using The Health Improvement Network, a UK primary care research database, 1988–2004. Maternal, household and child risk factors for injury were assessed among 2456 children with long-bone fractures (cases). 23 661controls were matched to cases on general practice. Adjusted ORs and 95% CIs were estimated using conditional logistic regression.
Results Fractures of long-bones were independently associated with younger maternal age and higher birth order, with children who were the fourth-born in the family, or later, having a threefold greater odds of fracture compared to first-born children (adjusted OR 3.12, 95% CI 2.08 to 4.68). Children over the age of 1 year had a fourfold (13–24 months, adjusted OR 4.09 95% CI 3.51 to 4.76) to fivefold (37+ months, adjusted OR 4.88 95% CI 4.21 to 5.66) increase in the odds of a long-bone fracture compared to children aged 0–12 months. Children in families with a history of maternal alcohol misuse had a raised odds of long-bone fracture (adjusted OR 2.33, 95% CI 1.13 to 4.82) compared to those with no documented history.
Conclusions Risk factors for long-bone fractures in children less than 5 years old included age above 1 year, increasing birth order, younger maternal age and maternal alcohol misuse. These risk factors should be used to prioritise families and communities for injury prevention interventions.
Injuries in childhood are an important preventable cause of morbidity and mortality, leading to approximately 2 million emergency department (ED) attendances and 120 000 hospital admissions each year among children aged 1–14 in the UK. Fractures are an important injury as nearly all lead to ED attendance, with some cases requiring hospital admission, or an operative procedure. The anatomical site and severity of a fracture are important in terms of treatment required, risk of complications and functional outcome. Long-bone fractures occurring in the femur, tibia, fibula, humerus, radius or ulna, have been used at a population level as an indicator of more severe injuries.
Guidance by the National Institute for Health and Care Excellence (NICE) recommends the identification of households with children at greatest risk of injury in order to target preventative interventions, such as home safety assessments and safety equipment provision. Injuries among children less than 5 years old most commonly occur within the home, with fractures most commonly resulting from falls. Among young children, intentional injury is also an important cause of fractures, potentially accounting for up to 25% of fractures in children less than 12 months. Understanding risk factors for long-bone fractures can help preventative efforts to be targeted towards these more severe injuries.
Existing studies have demonstrated that child age, sex, deprivation, household size, maternal age and birth order influence fracture risk. However, few have assessed risk factors for long-bone fractures. We therefore aimed to investigate risk factors for long-bone fractures in children less than 5 years old using a large UK primary care database.
Abstract and Introduction
Abstract
Aim To investigate risk factors for first long-bone fractures in children up to 5 years old in order to provide evidence about which families could benefit from injury prevention interventions.
Methods Population-based matched nested case–control study using The Health Improvement Network, a UK primary care research database, 1988–2004. Maternal, household and child risk factors for injury were assessed among 2456 children with long-bone fractures (cases). 23 661controls were matched to cases on general practice. Adjusted ORs and 95% CIs were estimated using conditional logistic regression.
Results Fractures of long-bones were independently associated with younger maternal age and higher birth order, with children who were the fourth-born in the family, or later, having a threefold greater odds of fracture compared to first-born children (adjusted OR 3.12, 95% CI 2.08 to 4.68). Children over the age of 1 year had a fourfold (13–24 months, adjusted OR 4.09 95% CI 3.51 to 4.76) to fivefold (37+ months, adjusted OR 4.88 95% CI 4.21 to 5.66) increase in the odds of a long-bone fracture compared to children aged 0–12 months. Children in families with a history of maternal alcohol misuse had a raised odds of long-bone fracture (adjusted OR 2.33, 95% CI 1.13 to 4.82) compared to those with no documented history.
Conclusions Risk factors for long-bone fractures in children less than 5 years old included age above 1 year, increasing birth order, younger maternal age and maternal alcohol misuse. These risk factors should be used to prioritise families and communities for injury prevention interventions.
Introduction
Injuries in childhood are an important preventable cause of morbidity and mortality, leading to approximately 2 million emergency department (ED) attendances and 120 000 hospital admissions each year among children aged 1–14 in the UK. Fractures are an important injury as nearly all lead to ED attendance, with some cases requiring hospital admission, or an operative procedure. The anatomical site and severity of a fracture are important in terms of treatment required, risk of complications and functional outcome. Long-bone fractures occurring in the femur, tibia, fibula, humerus, radius or ulna, have been used at a population level as an indicator of more severe injuries.
Guidance by the National Institute for Health and Care Excellence (NICE) recommends the identification of households with children at greatest risk of injury in order to target preventative interventions, such as home safety assessments and safety equipment provision. Injuries among children less than 5 years old most commonly occur within the home, with fractures most commonly resulting from falls. Among young children, intentional injury is also an important cause of fractures, potentially accounting for up to 25% of fractures in children less than 12 months. Understanding risk factors for long-bone fractures can help preventative efforts to be targeted towards these more severe injuries.
Existing studies have demonstrated that child age, sex, deprivation, household size, maternal age and birth order influence fracture risk. However, few have assessed risk factors for long-bone fractures. We therefore aimed to investigate risk factors for long-bone fractures in children less than 5 years old using a large UK primary care database.
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