The Positive Predictive Value of Rib Fractures as an Indicator of Nonaccidental Trauma in Children.
Barsness, Katherine A. MD; Cha, Eun-Suk MD; Bensard, Denis D. MD; Calkins, Casey M. MD; Partrick, David A. MD; Karrer, Frederick M. MD; Strain, John D. MD
[Article] Journal of Trauma-Injury Infection & Critical Care. 54(6):1107-1110, June 2003.

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Background: Rib fractures have a strong association with nonaccidental trauma (NAT) and severe trauma. The purposes of this study were to evaluate rib fractures in children to determine (1) the positive predictive value of a rib fracture in defining NAT and (2) the frequency of rib fractures as the only skeletal manifestation of NAT.

Methods: We reviewed the medical records and imaging of all children with rib fractures over a 6-year period. NAT was determined by the Child Advocacy and Protection team.

Results: In children younger than 3 years of age, the positive predictive value (PPV) of a rib fracture as an indicator of NAT was 95%. The positive predictive value increased to 100% once historical and clinical circumstance excluded all other causes for rib fractures.

Conclusion: In this study, rib fracture(s) were the only skeletal manifestation of NAT in 29% of the children.

(C) 2003 Lippincott Williams & Wilkins, Inc.