Prevalence and relevance of pediatric spinal fractures in suspected child abuse

Barber, Ignasi; Peréz-Rosselló, Jeannette M.; Wilson, Celeste R.; Silvera, Michelle; Kleinman, Paul K.

doi:10.1007/s00247-013-2726-x

Cited by 43 publications

(31 citation statements)

References 27 publications

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“…This study was limited to children ,24 months old. A recent study of SS1 found a higher incidence of spine fractures in children .24 months old than in children ,24 months old 28 ; thus, our results may not be freely generalized as to age. Finally, SS2 were obtained in only 27.2% of our eligible subjects.…”

Section: Discussioncontrasting

confidence: 70%

“…[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. The low initial prevalence of spine and pelvis fractures on both SS1 and SS2 supports decreasing repeated exposure by eliminating these views from SS2.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Sensitivity of the Limited View Follow-up Skeletal Survey

et al. 2014

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“…3,40,54 In infancy, excepting cases of abusive head injury, the rates of spinal injury associated with TBI have seemed to be quite low. 2,8,19,30 The current study reports spinal injury rates of 9.8% for NTDB admissions coded for TBI and 10.9% for admissions coded for GCS motor ≤ 4, but all spinal levels have been counted. Among admissions of patients whose clinical evaluations were obscured by intubation or sedation, the current study notes a prevalence of spinal injury of 16.7%.…”

Section: Discussionmentioning

confidence: 99%

Pediatric spinal injury in the US: epidemiology and disparities

Piatt¹

2015

PED

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OBJECT In the US, race and economic status have pervasive associations with mechanisms of injury, severity of injury, management, and outcomes of trauma. The goal of the current study was to examine these relationships on a large scale in the setting of pediatric spinal injury. METHODS Admissions for spinal fracture without or with spinal cord injury (SCI), spinal dislocation, and SCI without radiographic abnormality were identified in the Kids’ Inpatient Database (KID) and the National Trauma Data Bank (NTDB) registry for 2009. Patients ranged in age from birth up to 21 years. Data from the KID were used to estimate nationwide annual incidences. Data from the NTDB were used to describe patterns of injury in relation to age, race, and payor, with corroboration from the KID. Multiple logistic regression was used to model rates of mortality and spinal fusion. RESULTS In 2009, the estimated incidence of hospital admission for spinal injury in the US was 170 per 1 million in the population under 21 years of age. The incidence of SCI was 24 per 1 million. Incidences varied regionally. Adolescents predominated. Patterns of injury varied by age, race, and payor. Black patients were more severely injured than patients of other races as measured by Injury Severity Scale scores. Among black patients with spinal injury in the NTDB, 23.9% suffered firearm injuries; only 1% of white patients suffered firearm injuries. The overall mortality rate in the NTDB was 3.9%. In a multivariate analysis that included a large panel of clinical and nonclinical factors, black race retained significance as a predictor of mortality (p = 0.006; adjusted OR 1.571 [1.141–2.163]). Rates of spinal fusion were associated with race and payor in the NTDB data and with payor in the KID: patients with better insurance underwent spinal fusion at higher rates. CONCLUSIONS The epidemiology of pediatric spinal injury in the US cannot be understood apart from considerations of race and economic status.

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“…We recently reported a significant correlation between spinal fractures and intracranial injury (Fig. 4) [23]. Ten of 14 (71%) children with spinal fractures had intracranial injury; eight children had a combination of unilateral or bilateral subdural hematomas and brain parenchymal injury or subarachnoid hemorrhage suggestive of abusive head trauma [23].…”

Section: The Classic Metaphyseal Lesionmentioning

confidence: 97%

“…Ten of 14 (71%) children with spinal fractures had intracranial injury; eight children had a combination of unilateral or bilateral subdural hematomas and brain parenchymal injury or subarachnoid hemorrhage suggestive of abusive head trauma [23]. One of these children had an unsuspected skull fracture on skeletal survey with MRI findings suggesting hemorrhage along the margins of the tentorium and mild restricted diffusion in the cerebellar hemispheres [23]. Another child presented with right hemiparesis had brain MR findings initially interpreted as consistent with an acute ischemic injury; Fig.…”

Section: The Classic Metaphyseal Lesionmentioning

confidence: 99%

Imaging of skeletal injuries associated with abusive head trauma

Barber

Kleinman

2014

Pediatr Radiol

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Skeletal injuries are commonly encountered in infants and young children with abusive head trauma. Although certain patterns of intracranial injury suggest abuse, none are diagnostic. Therefore demonstration of associated unsuspected skeletal injuries has important implications, particularly when highly specific fractures are present. Skull fractures are commonly associated with intracranial injury, but no fracture pattern is indicative of physical abuse. Other skeletal injuries including classic metaphyseal lesions and rib, spine and scapular fractures are strong predictors of abusive head trauma in infants with intracranial injury. It is mandatory to perform rigorous skeletal surveys in infants and young children with clinical and neuroimaging findings concerning for abusive head trauma.

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Prevalence and relevance of pediatric spinal fractures in suspected child abuse

Abstract: Spinal fractures are not rare in children with positive skeletal surveys performed for suspected abuse and they may be the only indication of skeletal trauma. There is an association between spinal fractures and ICI.

Cited by 43 publications

References 27 publications

Sensitivity of the Limited View Follow-up Skeletal Survey

Sensitivity of the Limited View Follow-up Skeletal Survey

Pediatric spinal injury in the US: epidemiology and disparities

Imaging of skeletal injuries associated with abusive head trauma

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