Review of the new RCR guidelines (2017): The radiological investigation of suspected physical abuse in children

Halstead, S; Scott, G. M.; Thust, Stefanie; Hann, G

doi:10.1136/archdischild-2017-314591

Cited by 8 publications

(31 citation statements)

References 2 publications

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“…Despite several original studies (26)(27)(28)(29)(30)(31) and one narrative review (18) concluding that RSS and BS are complementary tests, discrepancies remain between international guidelines for the indication of BS in the diagnostic work-up of suspected physical abuse in children (15,16,36). There is a consensus that BS should not replace RSS given its lack of sensitivity for classical metaphyseal injuries.…”

Section: Discussionmentioning

confidence: 99%

“…During the study period, the local protocol for RSS agreed with international guidelines ( 6 , 15 , 16 , 36 ) with performance of frontal and profile skull views, frontal chest view, profile whole spine views, frontal unprepared abdominal view, frontal upper-limb (arms, forearms, hands) views, frontal lower-limb (thighs, legs, feet) views, and frontal pelvis views. A profile incidence of the chest was added with suspected rib injuries.…”

Section: Methodsmentioning

confidence: 99%

“…Radiological skeletal survey (RSS) is the currently recommended test for the diagnosis of inflicted skeletal injuries in all children under 2 years old with suspected physical abuse (6,(13)(14)(15)(16). However, RSS cannot be considered a reference standard because skeletal injuries of the ribs, hands, and feet, which are reliable indicators of child physical abuse (8)(9)(10)(11)(12)(13)17), may be inconspicuous or invisible on initial RSS (18-21).…”

Section: Introductionmentioning

confidence: 99%

“…However, RSS cannot be considered a reference standard because skeletal injuries of the ribs, hands, and feet, which are reliable indicators of child physical abuse (8)(9)(10)(11)(12)(13)17), may be inconspicuous or invisible on initial RSS (18-21). Thus, follow-up RSS after 2 weeks may help detect skeletal injuries missed on the initial RSS (14,18,19,21) and are recommended (6,(13)(14)(15)(16). Several reports have underscored the lack of adherence to follow-up RSS, mainly because of concerns about delaying the diagnosis (22)(23)(24)(25).…”

Section: Introductionmentioning

confidence: 99%

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Bone Scintigraphy After a Negative Radiological Skeletal Survey Improves the Detection Rate of Inflicted Skeletal Injury in Children

et al. 2020

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Background: Timely diagnosis of child physical abuse is of paramount importance. The added value of bone scintigraphy (BS) after a negative radiological skeletal survey (RSS) in children with suspected physical abuse has never been evaluated. Objective: The objective of this study was to assess the extent to which BS could improve the detection rate of skeletal injury in children with suspected physical abuse with an initial negative RSS. Methods: We used discharge codes to retrospectively identify children evaluated for suspected physical abuse in a university hospital (Nantes, France). We included all consecutive children younger than 3 years old who underwent both RSS and BS, with an interval of ≤96 h between tests, from 2013 to 2019. BS and RSS results were interpreted independently during the study period. We specifically analyzed BS results for children with a negative RSS to assess the value of BS as an add-on test. Results: Among the 268 children ≤3 years old with suspected physical abuse who underwent RSS, 140 (52%) also underwent BS within 96 h and were included in the analysis. The median age was 6 months old (interquartile range: 3-8). The detection rate of ≥1 skeletal injury with RSS alone was 49% (n = 69/140, 95% CI: 41-58%) vs. 58% (n = 81/140, 50-66%) with RSS followed by add-on BS, for an absolute increase in the detection rate of 9% points (95% CI: 4-14%). The number of children with a negative RSS who would need to undergo BS to detect one additional child with ≥1 skeletal injury was 6 (95% CI: 4-11). ADDED VALUE OF THIS STUDY Performing BS in young children with suspected physical abuse after a negative RSS would allow for a clinically significant improvement in the detection rate of skeletal injuries for a limited number of BS procedures required.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bone Scintigraphy After a Negative Radiological Skeletal Survey Improves the Detection Rate of Inflicted Skeletal Injury in Children

et al. 2020

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“…The radiographic skeletal survey is the primary imaging examination for detecting fractures with frontal, lateral, and also oblique views, especially to increase the accuracy of diagnosing rib fractures, which are strong positive predictors of abuse. 3,4 Furthermore, a follow-up skeletal survey, approximately 2 weeks later, increases the diagnostic yield. 5 Unfortunately, although all imaging studies are performed with exposure that is as low as reasonably achievable, the child can be exposed to a high dose of ionizing radiation.…”

mentioning

confidence: 99%

Possible Role of Thoracic Ultrasound in the Diagnostic Pathway of Infant Abuse in the Pediatric Emergency Department

Bloise

Martucci

Marcellino

et al. 2020

J of Ultrasound Medicine

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espite the fact that child maltreatment is a global problem with serious life-long physical and psychological or psychiatric outcomes, it is often difficult to detect. In the area of physical abuse, fractures are common in 12% to 20% of the cases, particularly in the youngest children in the first year of life. 1,2 Diagnostic imaging is an essential part of the investigation of suspected physical abuse. The radiographic skeletal survey is the primary imaging examination for detecting fractures with frontal, lateral, and also oblique views, especially to increase the accuracy of diagnosing rib fractures, which are strong positive predictors of abuse. 3,4 Furthermore, a follow-up skeletal survey, approximately 2 weeks later, increases the diagnostic yield. 5 Unfortunately, although all imaging studies are performed with exposure that is as low as reasonably achievable, the child can be exposed to a high dose of ionizing radiation. This aspect should not be underestimated; in fact, children are considered to have an increased risk of morbidity and mortality from radiation compared with their adult counterparts, because of both organ sensitivity and longer life expectancy. [6][7][8] Therefore, to reduce the dose of ionizing radiation and speed up diagnostic times, thoracic ultrasound could represent an effective diagnostic tool for early diagnosis of thoracic bone fractures in suspected physical child abuse in the emergency department.

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Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries

et al. 2021

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Key Points Question Are clinical guidelines for the early detection and diagnostic workup of child physical abuse complete, clear, and consistent across high-income countries? Findings In this systematic review that included 20 clinical guidelines issued in 15 countries, guidelines were clear but incomplete and discrepant, particularly in the definition of sentinel injuries and in recommendations for exploratory laboratory testing and advanced imaging. Meaning This systematic review found a lack of standardized guidelines for the identification and management of child physical abuse, which may contribute to practice variation.

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Review of the new RCR guidelines (2017): The radiological investigation of suspected physical abuse in children

Cited by 8 publications

References 2 publications

Bone Scintigraphy After a Negative Radiological Skeletal Survey Improves the Detection Rate of Inflicted Skeletal Injury in Children

Bone Scintigraphy After a Negative Radiological Skeletal Survey Improves the Detection Rate of Inflicted Skeletal Injury in Children

Possible Role of Thoracic Ultrasound in the Diagnostic Pathway of Infant Abuse in the Pediatric Emergency Department

Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries

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