Fingertip injuries may point to child abuse

FINGERTIP injuries may be a signal to healthcare providers that a child has been physically abused, according to a new study in the US.

The researchers found that young children who had suffered a fingertip injury were 23% more likely to have a documented history of abuse or neglect, compared to children who never had fingertip injuries.

The study looked at a New York database that tracks medical discharge records from more than 4.9 million children from infancy to age 12 who received emergency department care between 2004 and 2013.

Of those, the researchers identified more than 79,000 children who were treated for fingertip injuries, including crushing, tissue damage, and amputation. They then analysed the children’s medical histories for documentation of abuse.

“We found that children who had been coded at some point with physical abuse were more likely to have also been brought in for treatment of a fingertip injury,“said lead author Alice Chu, an associate professor of orthopaedic surgery and chief of the division of paediatric orthopaedics at Rutgers New Jersey Medical School.

Fingertip injuries were seen as significant because of the ways they often happen. The circumstances can be innocent, even due to something the child did to himself or herself. But fingertip injuries can also happen due to rough treatment of a child or an abuser slamming a door on a child’s fingers, or stepping on a child’s hands.

“There is no one injury type that is 100% predictive of child abuse, but all the small risk factors can add up,“Chu said. “Since fingertip injuries are mostly inflicted by someone else – whether intentional or accidental – it should be a signal to physicians to look deeper into the child’s medical history for signs of neglect or physical abuse.”

Fingertip injuries represent about two-thirds of all paediatric hand injuries, according to the study. They also account for 54% of all paediatric amputations.

“Currently, pediatric fingertip injuries typically are not considered an injury of abuse but one of accidental trauma or a clumsy child who gets his finger caught in a door,“said Chu. “Doctors need to see these instances as a possible injury from abuse or neglect so they can be on higher alert during the evaluation.”

The study was published in the January edition of the Journal of Hand Surgery Global Online.