{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T14:58:06Z","timestamp":1790521086647,"version":"4.1.0"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>The aim of this study was to evaluate incidence of prior fussy emergency visits in infants with subsequently diagnosed fractures suggestive of abuse.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This was a retrospective chart review of infants younger than 6 months who presented to the pediatric emergency department (ED) between January 1, 2006, and December 31, 2011. Inclusion criteria included age 0 to 6 months, discharge diagnosis including \u201cfracture,\u201d \u201cbroken\u201d (or break), or \u201ctrauma\u201d or any child abuse diagnosis or chief complaint of \u201cfussy\u201d or \u201ccrying\u201d as documented in the electronic medical record by the triage nurse.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Three thousand seven hundred thirty-two charts were reviewed, and 279 infants with fractures were identified. Eighteen (6.5%) of 279 infants had a prior ED visit for fussiness without an obvious source. Of these, 2 had a witnessed event causing their fracture, and therefore the fracture was not considered concerning for abuse. The remaining 16 had fractures concerning for abuse. Mean age was 2.5 (SD, 1.2) months. Fifteen (83%) of 18 infants were 3 months or younger at the time of the fussy visit. The mean interval between the first and second ED visits was 27 days (median, 20 days). Thirty-nine percent were evaluated by a pediatric emergency medicine\u2013trained physician during their initial fussy visit, whereas 78% were evaluated by pediatric emergency medicine\u2013trained physician during their subsequent visit. Most common injuries were multiple types of fractures followed by extremity and rib fractures.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Fractures concerning for child abuse are an important cause of unexplained fussiness in infants presenting to the pediatric ED. A high index of suspicion is essential for prompt diagnosis and likely prevention of other abuse.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000001106","type":"journal-article","created":{"date-parts":[[2017,3,28]],"date-time":"2017-03-28T20:12:22Z","timestamp":1490731942000},"page":"538-543","source":"Crossref","is-referenced-by-count":17,"title":["Missed Fractures in Infants Presenting to the Emergency Department With Fussiness"],"prefix":"10.1097","volume":"33","author":[{"given":"Jamie S.","family":"Kondis","sequence":"first","affiliation":[{"name":"From the *Department of Pediatrics, Washington University School of Medicine, St Louis, MO; and \u2020Department of Pediatrics, University of Arizona School of Medicine, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared","family":"Muenzer","sequence":"additional","affiliation":[{"name":"From the *Department of Pediatrics, Washington University School of Medicine, St Louis, MO; and \u2020Department of Pediatrics, University of Arizona School of Medicine, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet D.","family":"Luhmann","sequence":"additional","affiliation":[{"name":"From the *Department of Pediatrics, Washington University School of Medicine, St Louis, MO; and \u2020Department of Pediatrics, University of Arizona School of Medicine, Phoenix, AZ."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"bib1-20231023","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.jpeds.2010.04.072","article-title":"Abusive head trauma in children presenting with an apparent life-threatening event","volume":"157","year":"2010","journal-title":"J Pediatr"},{"key":"bib2-20231023","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1001\/jama.281.7.621","article-title":"Analysis of missed cases of abusive head trauma","volume":"281","year":"1999","journal-title":"JAMA"},{"key":"bib3-20231023","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/01.pec.0000208180.94166.dd","article-title":"Child abuse fatalities: are we missing opportunities for intervention?","volume":"22","year":"2006","journal-title":"Pediatr Emerg Care"},{"key":"bib4-20231023","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1097\/01.pec.0000081234.20228.33","article-title":"Fractures in young children: are physicians in the emergency department and orthopedic clinics adequately screening for possible abuse?","volume":"19","year":"2003","journal-title":"Pediatr Emerg Care"},{"key":"bib5-20231023","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1097\/PEC.0b013e31818e9f5d","article-title":"Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse","volume":"24","year":"2008","journal-title":"Pediatr Emerg Care"},{"key":"bib6-20231023","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1046\/j.1440-1754.2000.00515.x","article-title":"Rib fractures in infants: red alert! 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