Double-read of skeletal surveys in suspected non-accidental trauma: what we learned

Abstract

Double-read of skeletal survey for suspected non-accidental trauma found false-negative fractures in a few cases and rarely found false-positive diagnosis of a fracture. Double-read uncommonly found discrepancies in an initially normal skeletal survey. Limiting double-read to initially positive studies improves the yield of the double-read.

Imaging of non‐accidental injury; what is clinical best practice?

“…There is no ‘typical’ presentation of an abused child . Fractures through the entire skeleton are the second most common findings of NAI, after cutaneous lesions such as bruises . Abusive fractures are more common in children under 18 months old .…”

“…Ultrasound is used as an extension of the physical examination and as an adjunct to traditional imaging methods . Flourine 18‐labelled sodium fluoride (F‐NaF) positron emission tomography, with its high spatial resolution, has advantages in bone imaging . These techniques are performed on a case‐by‐case basis…”

“…Radiologic findings are a significant factor in the decision‐making of physicians about reporting to child protective services . Missing a fracture in cases of suspected NAI can have devastating consequences . Double reading in cases of suspected NAI helps ensure injuries are neither missed nor over‐called …”

“…Missing a fracture in cases of suspected NAI can have devastating consequences . Double reading in cases of suspected NAI helps ensure injuries are neither missed nor over‐called …”

“…20 Fractures through the entire skeleton are the second most common findings of NAI, after cutaneous lesions such as bruises. 18,[21][22][23][24] Abusive fractures are more common in children under 18 months old. 23 Suspicion of NAI increases when the mechanism of injuries are discordant with the caregiver's history and the child's developmental status, or when occult fractures are discovered.…”