Advertisement

Pediatric Radiology

, Volume 39, Issue 9, pp 962–968 | Cite as

Follow-up skeletal surveys for nonaccidental trauma: can a more limited survey be performed?

  • Susan R. Harlan
  • G. William Nixon
  • Kristine A. Campbell
  • Karen Hansen
  • Jeffrey S. PrinceEmail author
Original Article

Abstract

Background

Studies have demonstrated the value of the follow-up skeletal survey in identifying additional fractures, clarifying indeterminate findings, and improving dating of skeletal injuries in victims of physical abuse.

Objective

To determine whether a more limited follow-up survey could yield the same radiologic data as a full follow-up survey.

Materials and methods

The study cohort comprised 101 children who had follow-up surveys that met our inclusion criteria. Consensus readings of both original and follow-up surveys were performed by two pediatric radiologists. These results were compared to determine additional findings from the follow-up surveys. Limited skeletal survey protocols were evaluated to determine whether they would detect the same fractures seen with a complete osseous survey.

Results

In the 101 children 244 fractures were identified on the initial osseous survey. Follow-up surveys demonstrated new information in 38 children (37.6%). A 15-view limited follow-up survey identified all additional information seen on the complete follow-up survey.

Conclusion

Our data demonstrate that a 15-view limited follow-up skeletal survey could be performed without missing clinically significant new fractures and still allow proper identification of confirmed fractures or normal findings. A limited survey would decrease radiation dose in children.

Keywords

Child abuse Skeletal survey 

References

  1. 1.
    Slovis TL, Smith WL, Strain JD (2005) Suspected physical abuse – child. ACR appropriateness criteria. http://acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonPediatricImaging/SuspectedPhysicalAbuseChildDoc9.aspx. Accessed 26 May 2009
  2. 2.
    American College of Radiology (2006) ACR practice guideline for skeletal surveys in children. Resolution 22. American College of Radiology, Reston, VA. http://acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/pediatric/skeletal_surveys.aspx. Accessed 26 May 2009
  3. 3.
    American Academy of Pediatrics (2000) Diagnostic imaging of child abuse. Pediatrics 105:1345–1348CrossRefGoogle Scholar
  4. 4.
    Kleinman PK, Mimkine K, Spevak MR et al (1996) Follow-up skeletal surveys in suspected child abuse. AJR 167:893–896PubMedGoogle Scholar
  5. 5.
    Zimmerman S, Makoroff K, Care M et al (2005) Utility of follow-up skeletal surveys in suspected child physical abuse evaluations. Child Abuse Negl 29:1075–1083PubMedCrossRefGoogle Scholar
  6. 6.
    Hansen K, Prince JS, Nixon GW (2008) Oblique chest views as a routine part of skeletal surveys performed for possible physical abuse – is this practice worthwhile? Child Abuse Negl 32:155–159PubMedGoogle Scholar
  7. 7.
    Ingram JD, Connell J, Hay TC et al (2000) Oblique radiographs of the chest in nonaccidental trauma. Emerg Radiol 7:42–46CrossRefGoogle Scholar
  8. 8.
    Anilkumar A, Fender LJ, Broderick NJ et al (2006) The role of the follow-up chest radiograph in suspected non-accidental injury. Pediatr Radiol 36:216–218PubMedCrossRefGoogle Scholar
  9. 9.
    Kleinman PK, Marks SC Jr, Richmond JM et al (1995) Inflicted skeletal injury: a postmortem radiologic-histopathologic study in 31 infants. AJR 165:647–650PubMedGoogle Scholar
  10. 10.
    Belfer RA, Klein BL, Orr L (2001) Use of the skeletal survey in the evaluation of child maltreatment. Am J Emerg Med 19:122–124PubMedCrossRefGoogle Scholar
  11. 11.
    Day F, Clegg S, McPhillips M et al (2006) A retrospective case series of skeletal surveys in children with suspected non-accidental injury. J Clin Forensic Med 13:55–59PubMedCrossRefGoogle Scholar
  12. 12.
    Merten DF, Radkowski MA, Leonidas JC (1983) The abused child: a radiological reappraisal. Radiology 146:377–381PubMedGoogle Scholar
  13. 13.
    Carty H, Pierce A (2002) Non-accidental injury: a retrospective analysis of a large cohort. Eur Radiol 12:2919–2925PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Susan R. Harlan
    • 1
  • G. William Nixon
    • 2
  • Kristine A. Campbell
    • 3
  • Karen Hansen
    • 3
  • Jeffrey S. Prince
    • 2
    Email author
  1. 1.Department of RadiologyUniversity of Utah School of MedicineSalt Lake CityUSA
  2. 2.Department of Medical ImagingPrimary Children’s Medical CenterSalt Lake CityUSA
  3. 3.Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA

Personalised recommendations