Mimicking Child Physical Abuse: is there a place in CAN literature for Osteogenesis imperfecta?

Background: Osteogenesis Imperfecta (OI) is a hereditary connective tissue disorder. Typical manifestations are fragile bones with multiple bone fractures and bone deformities. A history of minimal or no trauma and recurrent fractures are features of OI, but they are also typical of Child Physical Abuse (CPA). OI and CPA are relevant differential diagnoses when a child presents with unexplained fractures. Objective: Quantify the weight and the trends of the worldwide literature on OI and CPA, in order to measure if and how the 2 topics overlap and are studied together. Method: A retrospective bibliometric analysis was carried out, utilizing the search engine of NIH, PubMed. The worldwide literature was explored and the 2 quoted phrases Osteogenesis Imperfecta (OI), Child Physical Abuse (CPA) were searched in all available manuscripts. Starting from retrieved papers, information on title, author(s), affiliation, source, journal, publication year, language and abstract were collected and recorded in 2 dedicated databases (DB) that are finally merged all in one in order to identify the overlapping area. A descriptive analysis and a text mining search were performed utilizing SAS software. Results: The search retrieved 7,140 manuscripts, distributed per interval period per each DB as follows: OI 48% (1950-2006), CPA 52% (1950-2006). English is the leading language of publication: OI 70% and CPA 93%. For both the DBs the top Countries of publication are United States of America and UK. An overlapping area exists between OI & CPA: 70 manuscripts representing the 1% of the whole (1969-2006). The prevalent language of publication is English (84%) and the most frequent countries of publication are United States of America and UK (45% and 29%). Further results on typology/journal of publication and text mining search will follow. Conclusion: The results obtained show that on this issue, the Anglophone countries demonstrate a predominant interest and therefore understanding the English language results fundamental to update oneself. Moreover, the nearly absent overlapping area among different DBs shows isolation (from a bibliometric point of view) of issue that are strongly related in reality. Practically, this means that a bibli- ographic search on the broad theme on child physical abuse/differential diagnosis could be easily biased retrieving incomplete results, with the continuous risk of falling in a bibliographic cul-de-sac. There is the need, especially in CAN literature, to implement the issue of differential diagnosis in order to allow the increasing of pro- fessionals’ self education & training.