Torn frenulum and non-accidental injury in children
Report By: Stewart Teece - Clinical Research Fellow
Search checked by Ian Crawford - Clinical Research Fellow
Institution: Manchester Royal Infirmary
Date Submitted: 7th February 2003
Date Completed: 7th February 2005
Last Modified: 8th November 2004
Status: Green (complete)
Three Part Question
In [a child] with [a torn frenulum] what [is the sensitivity and specificity of this sign as an indicator of non-accidental injury]?
A 2 year old child is brought to the department with bleeding from a mouth injury. His father states that he fell over pushing his dummy into his mouth. The child has no other obvious injury and although the mechanism of injury sounds plausible you find a torn frenulum on examining his mouth. Remembering this as an indicator of non-accidental injury you wonder whether this injury alone is sensitive/specific enough to support this diagnosis.
Medline 1966-10/04 using the Ovid interface.
[exp Labial Frenum OR exp lingual frenum OR frenum.af. OR frenulum.af OR exp lip OR lip.af] AND [exp Child abuse, sexual OR exp Child abuse OR abuse.af OR exp Battered child syndrome OR batter$.af OR exp Violence OR violen$.af OR assault.af OR non-accidental.af OR dummy.af OR dummies.af OR exp Sucking Behavior/ OR exp Pacifiers OR pacifier.af] LIMIT to human AND English language.
Altogether 104 papers found none of which answer the three part question.
Clinical Bottom Line
There appears to be no evidence for the sensitivity/specificity of torn frenulum in the investigation of non-accidental injury.