Sensitivity of the Limited View Follow-up Skeletal Survey

Hansen, Karen; Keeshin, Brooks; Flaherty, Emalee G.; Newton, Alice W.; Passmore, Sarah; Prince, Jeffrey S.; Campbell, Kristine A.

doi:10.1542/peds.2013-4024

Cited by 21 publications

(12 citation statements)

References 28 publications

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“…With the evidence of potential radiation risks, some authors have considered the performance of a limited follow‐up skeletal survey. A study by Hansen et al, looking at 534 cases of suspected NAI, found that a limited follow‐up skeletal survey, omitting the spine and pelvic views, missed 0.2% of new findings. The authors noted no clinically significant difference between the complete and the limited view follow‐up skeletal surveys.…”

Section: Resultsmentioning

confidence: 99%

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

Nguyen

Hart

2018

J of Medical Radiation Sci

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Non‐accidental injury (NAI) remains the leading cause of morbidity and mortality in children. Fractures are the second most common findings of NAI, after cutaneous lesions such as bruises and contusions. Imaging in NAI remains a controversial issue with little agreement concerning how, when and what imaging modalities should be used in the investigation of suspected cases. This review addresses the radiological investigations and findings of NAI, and the differential diagnoses of these findings. Adherence to the international guidelines for skeletal survey imaging is recommended. This ensures the content and quality of the radiographic series are of an optimal standard to improve the detection of occult fractures, and ensuring the accurate reporting of images. The involvement of a paediatric radiologist is important, if not essential in the diagnosis of NAI. In the evaluation of suspected cases, the role of the radiologist includes the detection of radiological findings suggestive of NAI, and the differentiation of these findings from normal variants and underlying pathologies. The diagnosis of NAI relies not only on radiological imaging, but also a combination of clinical and social findings. It is mandatory that all physicians work in close collaboration to improve diagnostic accuracy, as failure to diagnose NAI carries significant risk for morbidity.

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Section: Resultsmentioning

confidence: 99%

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

Nguyen

Hart

2018

J of Medical Radiation Sci

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“…This is not an insignificant change in diagnosis. In fact, the change in diagnostic decision from reversing social risk is a more significant change in diagnostic decisions than has been documented with follow-up skeletal surveys, a strongly recommended diagnostic test in the evaluation of child physical abuse [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Perceived social risk in medical decision-making for physical child abuse: a mixed-methods study

et al. 2017

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BackgroundThe medical literature reports differential decision-making for children with suspected physical abuse based on race and socioeconomic status. Differential evaluation may be related to differences of risk indicators in these populations or differences in physicians’ perceptions of abuse risk. Our objective was to understand the contribution of the child’s social ecology to child abuse pediatricians’ perception of abuse risk and to test whether risk perception influences diagnostic decision-making.MethodsThirty-two child abuse pediatrician participants prospectively contributed 746 consultations from for children referred for physical abuse evaluation (2009–2013). Participants entered consultations to a web-based interface. Participants noted their perception of child race, family SES, abuse diagnosis. Participants rated their perception of social risk for abuse and diagnostic certainty on a 1–100 scale. Consultations (n = 730) meeting inclusion criteria were qualitatively analyzed for social risk indicators, social and non-social cues. Using a linear mixed-effects model, we examined the associations of social risk indicators with participant social risk perception. We reversed social risk indicators in 102 cases whilst leaving all injury mechanism and medical information unchanged. Participants reviewed these reversed cases and recorded their social risk perception, diagnosis and diagnostic certainty.ResultsAfter adjustment for physician characteristics and social risk indicators, social risk perception was highest in the poorest non-minority families (24.9 points, 95%CI: 19.2, 30.6) and minority families (17.9 points, 95%CI, 12.8, 23.0). Diagnostic certainty and perceived social risk were associated: certainty increased as social risk perception increased (Spearman correlation 0.21, p < 0.001) in probable abuse cases; certainty decreased as risk perception increased (Spearman correlation (−)0.19, p = 0.003) in probable not abuse cases. Diagnostic decisions changed in 40% of cases when social risk indicators were reversed.ConclusionsCAP risk perception that poverty is associated with higher abuse risk may explain documented race and class disparities in the medical evaluation and diagnosis of suspected child physical abuse. Social risk perception may act by influencing CAP certainty in their diagnosis.

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“…This number is not insignificant and is consistent with other studies, which have reported the rates of new information identification to be between 8% and 46%. 10 , 11 , 18 , 19 Of those that received FUSS, 2 children were admitted to the hospital, and 3 children had change of disposition. One child was admitted after the identification of new rib fractures, and the other was admitted for possible skull fracture for further evaluation and a safe disposition.…”

Section: Discussionmentioning

confidence: 99%

Improving Follow-up Skeletal Survey Compliance in Suspected Nonaccidental Trauma Patients: What’s the FUSS About?

Gan

Draus

2018

Pediatric Quality &Amp; Safety

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Introduction:Nonaccidental trauma (NAT) victims account for a significant percentage of our pediatric trauma population. The skeletal survey (SS) and follow-up skeletal survey (FUSS) are essential in the evaluation of selected NAT patients. We identified that our clinically indicated FUSS completion rate was suboptimal. We hypothesized that implementing an intervention of postdischarge follow-up in our pediatric surgery clinic would improve FUSS completion rates.Methods:A follow-up clinic for NAT patients was established in July 2013. A retrospective review was performed of all suspected NAT cases younger than 2 years old seen at Kentucky Children’s Hospital between November 2012 and February 2014. The study population was divided into pre (Group 1) and postintervention (Group 2). Bivariate analysis was performed.Results:Group 1 consisted of 50 patients (58% male; median age, 9 months). Forty-7 (94%) had an SS; fractures were identified in 37 (74%) patients. Only 20 patients (40%) had FUSS; of those, 4 had newly identified fractures. Group 2 consisted of 52 patients (54% male; median age, 7 months). All 52 children (100%) had an SS; fractures were identified in 35 (67%) patients. Forty-seven patients (90%) had FUSS. Of those, 6 had new radiographic findings. Thirty-five patients (67%) were seen in our clinic. This improvement in FUSS (40% versus 90%) was statistically significant, P < 0.001.Conclusion:The decision to follow NAT patients in our clinic had significantly increased our rates of FUSS completion. This additional clinic follow-up also provided more evidence for NAT evaluation.

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Sensitivity of the Limited View Follow-up Skeletal Survey

Cited by 21 publications

References 28 publications

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

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

Perceived social risk in medical decision-making for physical child abuse: a mixed-methods study

Improving Follow-up Skeletal Survey Compliance in Suspected Nonaccidental Trauma Patients: What’s the FUSS About?

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