The majority of paediatric fractures result from accidental trauma such as traffic accidents, falls or while playing sports.[
1,
2] Nevertheless, in 25–56% of young children (< 1 year), fractures are caused by non-accidental trauma.[
2] All healthcare professionals treating children in their daily practice should be aware of this cause, especially in pre-ambulatory children, [
3,
4] and they should be able to recognize ‘red flags’ linked to non-accidental trauma.[
5] The child’s age, level of development, type of fracture and fracture location are main indicators that show whether or not the child suffers from non-accidental trauma.[
1] Children with femur fractures are often referred for evaluation to Child Abuse and Neglect teams (CAN), due to the high prevalence of reported non-accidental femur fractures among young children, ranging from 16.7 to 35.2% (< 12 months old) versus 1.5 to 6.0% for older children.[
4] Additional risk factors of non-accidental femur fractures have a suspicious history, non-ambulatory status and presence of additional injuries on physical examination. Fracture morphology and fracture side are not associated with non-accidental trauma. [
4] Especially because classification depends on the experience of healthcare professionals.[
6] In other words, different healthcare professionals may classify the same femur fracture differently. In addition, Pandya et al. showed that in the case of young children (< 18 months old) with femur fracture, the odds ratio of abuse is 1.8, in contrary to older children (between 18 months and 4 years old), with an odds ratio of 0.3. [
7] Therefore, it is of utmost importance that healthcare professionals are able to differentiate between non-accidental trauma and accidental trauma. Particularly, if the child has an isolated femur fracture, the orthopaedic or paediatric surgeon will probably be the only doctor involved in the treatment.
As previously stated, a femur fracture can in young children be an indicator of non-accidental trauma.
An important concept of forensic medicine is to dissociate extraneous context while investigating and judging information. Experts’ decision should be based on task-relevant information, in order to make an unbiased interpretation of the presented findings. [
8] Likewise, dissociation of nonessential context is vital in the diagnostic process of possible non-accidental trauma, to prevent diagnostic errors. Dror et al. highlighted that emotional context and irrelevant context biases experts and non-experts in their judgement on fingerprint identifications. [
8] Erroneous identification of medical findings influences the diagnosis and may change the healthcare worker’s decision-making. In order to avoid contamination of the objectivity of findings, we have to identify these cognitive errors. As hypothesized above, erroneous information may influence healthcare professionals in their judgement on medical findings within the diagnostic process of non-accidental trauma of femur fractures in young children. In this study, we asked the participants specifically whether or not the findings on the radiograph had additional evidentiary value in their judgement of the possibility of non-accidental trauma. Hence, we were interested in their judgement on the value of the medical findings itself, not in their judgement on child abuse as diagnosis of the case. The aim of this study was to investigate how, and to which degree, contextual information influences the judgement on the evidential value of medical findings by healthcare professionals.