Data were examined from 20 US child abuse teams, all of which used a common screening protocol for the contacts of physically abused children with serious injuries. The protocol specified physical examination of any contact child aged <5 years and skeletal survey as well as the physical examination for a contact child <24 months old. Contacts aged <6 months underwent neuroimaging as well as skeletal survey and physical examination. Of the 134 contact children aged <24 months, protocol-indicated skeletal survey identified at least 1 abusive fracture in 16 (11.9%) of these children. None of these fractures had associated findings on physical examination. No injuries were identified by neuroimaging in 19 of 25 eligible contacts. Twins were at substantially increased risk of fracture relative to non-twin contacts (odds ratio 20.1).
