# An injury plausibility assessment model for differentiating abusive from accidental fractures in young children

> **NIH NIH R01** · LURIE CHILDREN'S HOSPITAL OF CHICAGO · 2020 · $724,840

## Abstract

PROJECT SUMMARY / ABSTRACT
Child abuse is a public health epidemic with devastating consequences for young children. In 2017, there were
676,000 victims of child abuse and neglect in the United States including approximately 1700 deaths. Young
children are especially vulnerable - 81% of these deaths occurred among children 0-3 years old. Physical child
abuse results in over 120,000 cases a year (less than a quarter of all abuse cases), but accounts for over half
of the deaths, speaking to the heightened risk for a child. Fractures are the most common serious injury
from physical abuse, occurring more often than abuse-related traumatic brain injury and abdominal injury
combined. Each year in the United States there are more than 90,000 emergency department visits for
fractures in children age 0-5 years (most often involving the long bones), with abuse-related fractures peaking
in the first 3 years of life. It can be extremely difficult for providers to differentiate abuse-related fractures from
those associated with an accident in these young children. This difficulty results in a bidirectional problem:
under evaluation and missed abuse for some (which may result in re-injury or even death), and over evaluation
for abuse and reporting to state child protective services (CPS) for others (which also impacts families
negatively, and occurs most often in race/ethnic minority groups). Such “bidirectional” errors in decision
making come at a high cost to all involved. These issues highlight the critical need for an evidence-based
fracture assessment model to inform medical decision-making when attempting to differentiate abusive from
accidental fractures. To address this need, we developed and tested a fracture injury plausibility assessment
model (FxIPAM) in 201 children with long bone fractures. We demonstrated its capability to differentiate
abuse-related fractures from those resulting from accidental trauma and also demonstrated its theoretical
potential to decrease race/ethnic disparities in rates of abuse evaluations, based on model scoring results.
Before implementation, validation is required. The goal of this study is to validate an evidence-based model
for fracture assessments to improve the clinician’s ability to differentiate abuse from accidental fractures in
young children. Therefore, we propose the following aims in a prospective multicenter study of 1000 children,
0-3 years of age, with a long bone fracture: 1) Validate our FxIPAM model by determining its predictive
accuracy to differentiate between abuse vs. accidental long bone fractures, and 2) estimate the impact of a
hypothetical application of the FxIPAM on abuse assessments and reporting to CPS across race/ethnic
groups. Success of this study will result in the first validated model for fracture assessments in young children.
The intent of the FxIPAM is not to diagnose abuse but to function as a screening tool to identify children at risk
for abuse who require further evaluation a...

## Key facts

- **NIH application ID:** 10033417
- **Project number:** 1R01HD102428-01
- **Recipient organization:** LURIE CHILDREN'S HOSPITAL OF CHICAGO
- **Principal Investigator:** GINA E. BERTOCCI
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $724,840
- **Award type:** 1
- **Project period:** 2020-09-04 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10033417

## Citation

> US National Institutes of Health, RePORTER application 10033417, An injury plausibility assessment model for differentiating abusive from accidental fractures in young children (1R01HD102428-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10033417. Licensed CC0.

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