A retrospective case series of skeletal surveys in children with suspected non-accidental injury

Day, F. T.; Clegg, Sarah; McPhillips, Maeve; Mok, Jacqueline

doi:10.1016/j.jcfm.2005.08.001

Cited by 59 publications

(44 citation statements)

References 11 publications

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“…For this reason, the 10.8% rate of positive SS results in our sample is probably more accurate for current clinical practice than rates observed in previous studies of children hospitalized because of abuse. [10][11][12]20 The large proportion of subjects with healing fractures detected through SSs is consistent with our knowledge that abuse is a cycle and that children who are returned to abusive homes often are abused again. It also suggests that there might have been previous opportunities to make a diagnosis of abuse for these children.…”

Section: Discussionsupporting

confidence: 73%

“…The race of children is not documented as part of our hospital's records. Age was categorized into 5 categories (Ͻ6 months, 6 -11.9 months, 12-23.9 months, 24 -58.9 months, or Ͼ59 months) on the basis of a combination of the AAP recommendations related to the SS, previous studies that demonstrated that ages of Ͻ12 months were associated with a greater probability of positive SS results, [10][11][12] and our own belief that, within the Ͻ12-month-old age group, those Ͻ6 months of age would be most likely to have positive SS results. By using an iterative process involving a review of 50 randomly selected cases, 2 investigators (Ms Duffy and Dr Squires) developed categories for reasons for presentation to the hospital (Table 1) and reasons for the SS ( Table 2).…”

Section: Data Collectedmentioning

confidence: 99%

“…[7][8][9] The number of studies that evaluated the use of the SS is remarkably limited, and they generally included only children for whom there was already strong suspicion or a diagnosis of abuse before a completed SS. [10][11][12] Not surprisingly, large proportions of children in those studies had fractures identified on the SS; for example, 24% and 33% of the subjects in the studies by Day et al 12 and Merten et al, 10 respectively, had fractures identified on SS.…”

mentioning

confidence: 99%

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Use of Skeletal Surveys to Evaluate for Physical Abuse: Analysis of 703 Consecutive Skeletal Surveys

2010

PEDIATRICS

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Section: Discussionsupporting

confidence: 73%

Section: Data Collectedmentioning

confidence: 99%

mentioning

confidence: 99%

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Use of Skeletal Surveys to Evaluate for Physical Abuse: Analysis of 703 Consecutive Skeletal Surveys

2010

PEDIATRICS

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“…[15][16][17][18][19][20][21][22][23][24][25][26][27][28] The small number of these fractures, and their frequent association with other evidence allowing the diagnosis of abuse, has triggered a suggestion that spine and pelvis views be omitted from SS1. 24,26 Others have opposed this viewpoint for spine fractures, 25,27,28 making the argument that there is high specificity for abuse when occult spine fractures are discovered, and that spine fractures, while uncommon, are not rare.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity of the Limited View Follow-up Skeletal Survey

et al. 2014

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BACKGROUND AND OBJECTIVE: Reducing radiation exposure to minimize risk has been emphasized in recent years. In child abuse, the risk of missing occult injuries is often believed to outweigh radiation risk associated with skeletal surveys. Our hypothesis was that there would be no clinically significant difference in results from a limited view, follow-up skeletal survey (SS2) protocol, which omits spine and pelvis views unless these views have findings on the initial skeletal survey (SS1), compared with a traditional SS2 protocol for radiographic evaluation of suspected physical abuse. METHODS: This study was a retrospective record review involving 5 child protection teams. Consultations for suspected physical abuse were reviewed to identify subjects <24 months of age who had an SS1 and a traditional SS2. The results of these studies were compared to identify subjects in which newly identified spine and pelvis fractures (fractures seen only on SS2 and not on SS1) would have been missed by using a limited view SS2 protocol. RESULTS: We identified 534 study subjects. Five subjects had newly identified spine fractures, and no subjects had newly identified pelvis fractures on traditional SS2 studies. Only 1 subject with a newly identified spine fracture would have been missed with the limited view SS2 protocol used in this study (0.2% [95% confidence interval: <0.005–1.0]). None of the newly identified fractures changed the abuse-related diagnosis. CONCLUSIONS: We found no clinically significant difference in the results of a limited view SS2 protocol versus a traditional SS2 protocol for radiographic evaluation of suspected abuse.

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“…SSs reveal fractures that are not clinically suspected on the basis of history or physical examination in 10% to 40% of children ,2 years old evaluated for suspected abuse. [1][2][3][4][5][6] In addition to identifying fractures requiring medical treatment, SSs can document fractures and other findings that do not require medical treatment but are important to safeguard the well-being of the child. Specific patterns of fractures can confirm a diagnosis of abuse and allow for protection of the child.…”

Section: What This Study Addsmentioning

confidence: 99%

Evaluation for Occult Fractures in Injured Children

2015

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OBJECTIVES: To examine variation across US hospitals in evaluation for occult fractures in (1) children ,2 years old diagnosed with physical abuse and (2) infants ,1 year old with injuries associated with a high likelihood of abuse and to identify factors associated with such variation. METHODS:We performed a retrospective study in children ,2 years old with a diagnosis of physical abuse and in infants ,1 year old with non-motor vehicle crash-related traumatic brain injury or femur fractures discharged from 366 hospitals in the Premier database from 2009 to 2013. We examined across-hospital variation and identified child-and hospital-level factors associated with evaluation for occult fractures.RESULTS: Evaluations for occult fractures were performed in 48% of the 2502 children with an abuse diagnosis, in 51% of the 1574 infants with traumatic brain injury, and in 53% of the 859 infants with femur fractures. Hospitals varied substantially with regard to their rates of evaluation for occult fractures in all 3 groups. Occult fracture evaluations were more likely to be performed at teaching hospitals than at nonteaching hospitals (all P , .001). The hospital-level annual volume of young, injured children was associated with the probability of occult fracture evaluation, such that hospitals treating more young, injured patients were more likely to evaluate for occult fractures (all P , .001).CONCLUSIONS: Substantial variation in evaluation for occult fractures among young children with a diagnosis of abuse or injuries associated with a high likelihood of abuse highlights opportunities for quality improvement in this vulnerable population.WHAT'S KNOWN ON THIS SUBJECT: Screening for occult fractures is a key component of the medical evaluation for young victims of suspected physical abuse. Little is known about adherence to occult fracture evaluation guidelines in children with suspected abuse cared for at non-pediatric-focused hospitals.WHAT THIS STUDY ADDS: Occult fracture evaluations were performed in half of young children diagnosed with abuse or injuries concerning for abuse in a large cohort of hospitals. Evaluations were more common at hospitals caring for higher volumes of young, injured children.

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A retrospective case series of skeletal surveys in children with suspected non-accidental injury

Cited by 59 publications

References 11 publications

Use of Skeletal Surveys to Evaluate for Physical Abuse: Analysis of 703 Consecutive Skeletal Surveys

Use of Skeletal Surveys to Evaluate for Physical Abuse: Analysis of 703 Consecutive Skeletal Surveys

Sensitivity of the Limited View Follow-up Skeletal Survey

Evaluation for Occult Fractures in Injured Children

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