Table 2.

Summary of Study Characteristics

Study (1st author, year)	Study Location / Source	Dates	Age (mo)	Inclusion Criteria	Exclusions	N	Study Methods / Bias Assessment
							Study Methods Rankinga	Represent- ative populationb	Clear selection criteria
Barsness, 2003	The Children’s Hospital, University of Colorado Health Sciences Center, Denver, CO, USA	6 year period	< 36	Rib fractures all types	None	62c	D/4	Yes	No
Bulloch, 2000	Children’s Hospital Medical Center, Cincinnati, Ohio & Winnipeg Children’s Hospital, Canada	1994-1997	< 12	Rib fractures all types	None	39	C/3a	Yes	Yes
Cadzow, 2000	Royal Children’s Hospital Brisbane, Brisbane, Australia	1994-1998	< 24	Rib fractures all types	None	18	D/1	Nod	No
Darling, 2014	Seattle Children's Hospital & Harborview Medical Center, Seattle, WA, USA	2003-2010	< 36	Rib fractures all types attributed to abuse or accidental trauma & evaluated in ED or inpatient setting	Determination of accidental or abusive etiology not clearly made, pathologic fracture	65	C/3b	No	Yes
Garcia, 1990	Children's National Medical Center, Washington, DC, USA	1985-1988	< 36	Rib fractures all types Blunt or penetrating trauma	None	11	C/4	No	No
Leventhal, 2007	Yale-New Haven Children’s Hospital, CT, USA	1979-1983 1991-1994 1999-2002	< 36	Rib fractures all types	Pathologic fracture	34c	C/3b	Yes	Yes
Leventhal, 2008	National (Kids’ Inpatient Database, USA)	2003	< 36	Rib fractures all types	Birth related hospitalization	1001c	C/4	Yes	Yes
Lucas- Herald, 2012	Three neonatal units, Glasgow, UK	2000-2010	< 12	Born at < 37 weeks gestational age Rib fractures all types	Rib fracture related to thoracotomy surgery	26 c	C/5	No	Yes
Pandya, 2009	Children's Hospital of Philadelphia, PA, USA	1998-2007	≤ 48	Rib fractures all types	Determination of accidental or abusive etiology not clearly made	105	D/4	No	No
Strouse, 1995	University of Michigan Medical Center, Ann Arbor, MI, USA	1992-1994	< 48	Rib fractures all types	None	35	D/4	Yes	Yes

Abbreviations: mo=months old; N=sample size; ED=emergency department.

^aPresents general study methodology ranking (A-D) and abuse determination methodology ranking (1-5). See Table 1 for description of the ranking scales. Some studies utilized multiple different methods to define cases of abuse or suspected abuse and therefore received more than one ranking.

^bPresents whether the study population is representative of children with rib fractures.

^cThe data presented are for the relevant subset of a larger study population which may have included children with other types of injuries, other ages, and/or from other time periods.

^dIt is unclear if the study population only includes children referred to suspected child abuse and neglect team.