Hospitalization for child physical abuse before hospitalization for osteogenesis imperfecta or severe hemophilia: A nationwide cohort study in France
Background: Accurately and quickly diagnosing cases of physical abuse in young children is crucial to preventing further abuse and protecting the victims. However, certain children may have diseases that look like abuse, such as osteogenesis imperfecta (also known as brittle bone disease, which makes bones fragile and easy to break) or severe hemophilia (a condition that causes heavy bleeding). It is therefore necessary to clearly distinguish these diseases from abuse to avoid misdiagnosis. Our study aimed to evaluate the risk of hospitalization for child physical abuse before receiving a diagnosis of osteogenesis imperfecta or severe hemophilia.
Methods: We used a national database that includes all hospital admissions in France. We followed all children born between 2010 and 2019 until they reached the age of 2, investigating how many were hospitalized for child physical abuse, osteogenesis imperfecta, or severe hemophilia.
Results: Of more than 6 million children, approximately 2,000 were hospitalized for abuse before age 2, 160 for osteogenesis imperfecta, and 400 for severe hemophilia. Among those hospitalized for abuse, 99.9% were not hospitalized later for osteogenesis imperfecta or severe hemophilia. Only 3 children were hospitalized later for osteogenesis imperfecta, with an average delay of 9 months between hospital stays, and none for severe hemophilia. The risk that a child hospitalized for osteogenesis imperfecta was previously hospitalized for physical abuse was very low (about 2%), and this risk was 57 times higher than for children without osteogenesis imperfecta.
Conclusions: These results reflect excellent current clinical practices in distinguishing abuse from osteogenesis imperfecta or severe hemophilia. Our results provide arguments against the so-called “denialist” hypotheses, which suggest that the lesions observed in cases of child physical abuse are linked to rare, undiagnosed genetic disorders.
https://www.sciencedirect.com/science/article/pii/S0145213425003370
By Flora Blangis
