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Follow-up skeletal surveys for nonaccidental trauma: can a more limited survey be performed?

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Abstract

Background

Studies have demonstrated the value of the follow-up skeletal survey in identifying additional fractures, clarifying indeterminate findings, and improving dating of skeletal injuries in victims of physical abuse.

Objective

To determine whether a more limited follow-up survey could yield the same radiologic data as a full follow-up survey.

Materials and methods

The study cohort comprised 101 children who had follow-up surveys that met our inclusion criteria. Consensus readings of both original and follow-up surveys were performed by two pediatric radiologists. These results were compared to determine additional findings from the follow-up surveys. Limited skeletal survey protocols were evaluated to determine whether they would detect the same fractures seen with a complete osseous survey.

Results

In the 101 children 244 fractures were identified on the initial osseous survey. Follow-up surveys demonstrated new information in 38 children (37.6%). A 15-view limited follow-up survey identified all additional information seen on the complete follow-up survey.

Conclusion

Our data demonstrate that a 15-view limited follow-up skeletal survey could be performed without missing clinically significant new fractures and still allow proper identification of confirmed fractures or normal findings. A limited survey would decrease radiation dose in children.

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References

  1. Slovis TL, Smith WL, Strain JD (2005) Suspected physical abuse – child. ACR appropriateness criteria. http://acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonPediatricImaging/SuspectedPhysicalAbuseChildDoc9.aspx. Accessed 26 May 2009

  2. American College of Radiology (2006) ACR practice guideline for skeletal surveys in children. Resolution 22. American College of Radiology, Reston, VA. http://acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/pediatric/skeletal_surveys.aspx. Accessed 26 May 2009

  3. American Academy of Pediatrics (2000) Diagnostic imaging of child abuse. Pediatrics 105:1345–1348

    Article  Google Scholar 

  4. Kleinman PK, Mimkine K, Spevak MR et al (1996) Follow-up skeletal surveys in suspected child abuse. AJR 167:893–896

    PubMed  CAS  Google Scholar 

  5. Zimmerman S, Makoroff K, Care M et al (2005) Utility of follow-up skeletal surveys in suspected child physical abuse evaluations. Child Abuse Negl 29:1075–1083

    Article  PubMed  Google Scholar 

  6. Hansen K, Prince JS, Nixon GW (2008) Oblique chest views as a routine part of skeletal surveys performed for possible physical abuse – is this practice worthwhile? Child Abuse Negl 32:155–159

    PubMed  Google Scholar 

  7. Ingram JD, Connell J, Hay TC et al (2000) Oblique radiographs of the chest in nonaccidental trauma. Emerg Radiol 7:42–46

    Article  Google Scholar 

  8. Anilkumar A, Fender LJ, Broderick NJ et al (2006) The role of the follow-up chest radiograph in suspected non-accidental injury. Pediatr Radiol 36:216–218

    Article  PubMed  Google Scholar 

  9. Kleinman PK, Marks SC Jr, Richmond JM et al (1995) Inflicted skeletal injury: a postmortem radiologic-histopathologic study in 31 infants. AJR 165:647–650

    PubMed  CAS  Google Scholar 

  10. Belfer RA, Klein BL, Orr L (2001) Use of the skeletal survey in the evaluation of child maltreatment. Am J Emerg Med 19:122–124

    Article  PubMed  CAS  Google Scholar 

  11. Day F, Clegg S, McPhillips M et al (2006) A retrospective case series of skeletal surveys in children with suspected non-accidental injury. J Clin Forensic Med 13:55–59

    Article  PubMed  Google Scholar 

  12. Merten DF, Radkowski MA, Leonidas JC (1983) The abused child: a radiological reappraisal. Radiology 146:377–381

    PubMed  CAS  Google Scholar 

  13. Carty H, Pierce A (2002) Non-accidental injury: a retrospective analysis of a large cohort. Eur Radiol 12:2919–2925

    PubMed  Google Scholar 

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Correspondence to Jeffrey S. Prince.

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Harlan, S.R., Nixon, G.W., Campbell, K.A. et al. Follow-up skeletal surveys for nonaccidental trauma: can a more limited survey be performed?. Pediatr Radiol 39, 962–968 (2009). https://doi.org/10.1007/s00247-009-1313-7

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  • DOI: https://doi.org/10.1007/s00247-009-1313-7

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