Evidence map›Paper›PMID 42570419›Full record

ArticleChild abuse & neglect2026

Outcomes of indeterminate fractures identified on skeletal surveys obtained during non-accidental trauma evaluations.

Sabrina M Darwiche, Irit R Rasooly, Joanne N Wood, Hansel J Otero, Helina Afework, Michael Edozie, Julian Lopez-Rippe, Amina N Khan, Jan Leonard, M Katherine Henry

Abstract read
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In one paragraph

Article in Child abuse & neglect, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Sabrina M DarwicheDivision of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Electronic address: darwiches@chop.edu.
Irit R RasoolyDivision of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Joanne N WoodDivision of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Hansel J OteroClinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, PA, USA.
Helina AfeworkDivision of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.
Michael EdozieDivision of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, PA, USA.
Julian Lopez-RippeDepartment of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Amina N KhanDepartment of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Jan LeonardDepartment of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
M Katherine HenryDivision of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Funding

CAPNET - Building Research Capacity in Child Abuse PediatricsR24HD098415 · NICHD · UNIVERSITY OF COLORADO DENVER · PI CAMPBELL, KRISTINE A, LINDBERG, DANIEL M · 2020 to 2024
$1.8M
Optimizing Usability, Generalizability, and Impact of CAPNET Multicenter Child Abuse Research Network DataR03HD119150 · NICHD · CHILDREN'S HOSP OF PHILADELPHIA · PI HENRY, MARIA KATHERINE, WOOD, JOANNE NICOLE · 2025 to 2025
$178k
AHRQ HHS K08 HS028682AHRQ HHS K08 HS028847NICHD NIH HHS R03 HD119150NICHD NIH HHS R24 HD098415
6 · The paper itself

Abstract

backgroundSkeletal surveys (SS), a critical component of non-accidental trauma (NAT) evaluations, may have indeterminate findings concerning for a possible fracture. The frequency and clinical impact of these indeterminate fractures is unknown.

objectivesIn children with SS obtained as part of NAT evaluations, 1) determine the prevalence and clinical characteristics of indeterminate fractures, 2) describe frequency and type of follow-up imaging, and 3) ascertain the potential impact of indeterminate fractures. PARTICIPANTS AND

settingA single-center, retrospective chart review of children <2 years who underwent an initial SS to evaluate for NAT, between January 2020 and March 2024.

methodsDescriptive statistics were used to calculate the frequency of indeterminate fractures, clinical characteristics, follow up imaging, and impact.

resultsOf 1198 initial SSs, 153 (13%) had at least 1 indeterminate fracture. These 153 SSs identified a total of 254 indeterminate fractures (median = 1, IQR 1-2), frequently classic metaphyseal lesions (25%, 64/254) or rib fractures (25%, 64/254). Most patients (93%, 143/153) underwent at least one clarifying imaging study; more than half (80, 52%) required >24 h for uncertainty resolution. A minority of indeterminate fractures were ultimately confirmed as true fractures (24%, 60/254). Seventy percent (107/153) of patients had concurrent, definitive injury and 55% (84/153) were referred to child protective services.

conclusionsOne in eight SSs identified at least one indeterminate fracture, often a fracture type highly specific for NAT. However, most were not true fractures, suggesting opportunities for improvement in SS workflow given the diagnostic implications.

Indexed as

Child AbuseFractures, BoneFemaleForensic ImagingHumansInfantMaleRetrospective StudiesChild physical abuseFracturesIndeterminateRadiography

Identifiers

PMID42570419
PMCPMC13577206

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.