The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children

J Trauma. 2003 Jun;54(6):1107-10. doi: 10.1097/01.TA.0000068992.01030.A8.


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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Validation Study

MeSH terms

  • Adolescent
  • Age Distribution
  • Child
  • Child Abuse / diagnosis*
  • Child Abuse / statistics & numerical data
  • Child, Preschool
  • Colorado / epidemiology
  • Comorbidity
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Predictive Value of Tests
  • Radiography
  • Retrospective Studies
  • Rib Fractures / diagnostic imaging
  • Rib Fractures / epidemiology*
  • Trauma Centers / statistics & numerical data
  • Wounds, Nonpenetrating / epidemiology