{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T22:16:32Z","timestamp":1771539392252,"version":"3.50.1"},"reference-count":15,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,1,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background And Objective:<\/jats:title>\n                  <jats:p>Delay in seeking medical care is one criterion used to identify victims of abuse. However, typical symptoms of accidental fractures in young children and the time between injury and the seeking of medical care have not been reported. We describe patient and injury characteristics that influence the time from injury to medical care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods:<\/jats:title>\n                  <jats:p>Parental interviews were conducted for children &amp;lt;6 years old with accidental extremity fractures. Demographic characteristics, signs and symptoms of the injury, and fracture location and severity were described and examined for their association with a delay (&amp;gt;8 hours) in seeking medical care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results:<\/jats:title>\n                  <jats:p>Among 206 children, 69% had upper extremity fractures. The median time to the first medical evaluation was 1 hour, but 21% were seen at &amp;gt;8 hours after injury. Although 91% of children cried after the injury, only 83% were irritable for &amp;gt;30 minutes. Parents observed no external sign of injury in 15% of children, and 12% used the injured extremity normally. However, all parents noted at least 1 sign or symptom. Minority children (odds ratio [OR]: 2.54 [95% confidence interval [CI]: 1.18\u20135.47), those with lower extremity injuries (OR: 2.23 [95% CI: 1.01\u20134.90]), those without external signs of injury (OR: 3.40 [95% CI: 1.36\u20138.51]), and those with continued extremity use (OR: 3.26 [95% CI: 1.22\u20138.76]) were more likely to delay seeking medical care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions:<\/jats:title>\n                  <jats:p>Although some children did not manifest all expected responses, no child with an accidental fracture was asymptomatic. Delay in seeking medical care was associated with more subtle signs of injury; however, delays identified in minority patients are unexplained.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2010-0691","type":"journal-article","created":{"date-parts":[[2011,12,6]],"date-time":"2011-12-06T03:34:43Z","timestamp":1323142483000},"page":"e128-e133","source":"Crossref","is-referenced-by-count":18,"title":["Symptoms and Time to Medical Care in Children With Accidental Extremity Fractures"],"prefix":"10.1542","volume":"129","author":[{"given":"Caitlin","family":"Farrell","sequence":"first","affiliation":[{"name":"Division of General Pediatrics,The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Rubin","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics,The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Safe Place: The Center for Child Protection and Health, Division of General Pediatrics,The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Policy Laboratory,The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Downes","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Hospital, Cincinnati, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Dormans","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania"},{"name":"Division of Pediatric Orthopaedic Surgery, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania Departments of"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cindy W.","family":"Christian","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics,The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Safe Place: The Center for Child Protection and Health, Division of General Pediatrics,The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2012,1,1]]},"reference":[{"key":"2021120902565436800_B1","volume-title":"Child Maltreatment 2009","author":"US Department of Health and Human Services, Administration on Children, Youth, and Families","year":"2010"},{"issue":"9576","key":"2021120902565436800_B2","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1016\/S0140-6736(07)60856-3","article-title":"Physical abuse and neglect of children","volume":"369","author":"Dubowitz","year":"2007","journal-title":"Lancet"},{"issue":"5","key":"2021120902565436800_B3","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1016\/S0031-3955(05)70449-1","article-title":"Orthopedic aspects of child abuse","volume":"43","author":"Cramer","year":"1996","journal-title":"Pediatr Clin North Am"},{"issue":"6","key":"2021120902565436800_B4","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1542\/peds.2007-0883","article-title":"Evaluation of suspected child physical abuse","volume":"119","author":"Kellogg","year":"2007","journal-title":"Pediatrics"},{"issue":"3","key":"2021120902565436800_B5","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1542\/peds.111.3.602","article-title":"Can the initial history predict whether a child with a head injury has been 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