228897 Increased weight status is significantly associated with pediatric forearm fractures from standing height falls vs. major trauma

Monday, November 8, 2010

Leticia Ryan, MD, MPH , Division of Emergency Medicine, Children's National Medical Center, Washington, DC
Stephen Teach, MD, MPH , Division of Emergency Medicine, Children's National Medical Center, Washington, DC
Kimberle Searcy, MPH , Child Health Advocacy Institute, Children's National Medical Center, Washington, DC
Steven Singer, MD , Department of Emergency Medicine, George Washington University Medical Center, Washington, DC
Rachel Wood, BS , Center for Clinical and Community Research, Children's National Medical Center, Washington, DC
Joseph Wright, MD, MPH , Child Health Advocacy Institute, Children's National Medical Center, Washington, DC
James Chamberlain, MD , Division of Emergency Medicine, Children's National Medical Center, Washington, DC
Background/Purpose: Rates of both pediatric forearm fractures and obesity are increasing. Among adults, radius fractures from low energy falls are associated with bone fragility. Among children, increased weight status may increase forearm fracture risk, particularly at low fall heights. Weight for age/gender > 95th percentile has a high specificity (96%) and reasonable positive predictive value (80%) in identifying obese children (body mass index > 95th percentile).

Methods: Retrospective analysis of patients 0-17 years evaluated for isolated forearm fractures at a large urban pediatric emergency department from 2003-2006. Bivariate analyses were used to compare fractures resulting from major trauma to those resulting from a fall from standing height.

Results/Outcomes: Of 929 forearm fractures, there were 54 (5.8%) with major trauma and 226 (24.3%) with a fall from standing height. The overall cohort was 64% male, 80.1% African-American, and had a mean age of 8.4 (± 3.9) years. Fall from standing height cases were significantly older [10.4 (± 3.4) vs 7.4 (± 4.2) years, p< 0.05], had significantly more radius-only fractures, and had greater odds of having a weight for age/gender >95th percentile [OR 2.41 (95% CI 1.08-5.42)]. These groups did not differ in gender, race/ethnicity, or injury season.

Conclusions: Fall from standing height is a common mechanism of pediatric forearm fracture and is significantly associated with increased weight status and radius-only fractures. These data provide additional rationale for aggressively addressing obesity and investigating bone health among affected children.

Learning Objectives:
1. Identify the most common mechanisms of forearm fracture in children. 2. List 3 person-level factors which are associated with forearm fracture risk in children. 3. Describe 2 factors related to obesity which may increase forearm fracture risk in children.

Keywords: Injury, Children and Adolescents

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an pediatric emergency medicine physician and clinical researcher in the area of forearm fracture risk in children
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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