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Pediatric Radiology

, Volume 42, Issue 4, pp 463–469 | Cite as

Long bone fracture detection in suspected child abuse: contribution of lateral views

  • Boaz Karmazyn
  • Ryan D. Duhn
  • S. Gregory Jennings
  • Matthew R. Wanner
  • Bilal Tahir
  • Roberta Hibbard
  • Ralph Hicks
Original Article

Abstract

Background

ACR guidelines for routine skeletal survey for child abuse recommend only AP radiographs of the long bones; however, many institutions add lateral radiographs.

Objectives

To evaluate whether adding lateral radiographs for long bones changes the frequency and confidence of fracture detection in skeletal survey radiographs for suspected abuse.

Materials and methods

We identified 100 children younger than 2 years of age who underwent skeletal survey for child abuse; 56 with multiple long bone fractures, 22 with a single fracture and 22 with no fractures. Four radiologists (two pediatric radiologists, one pediatric radiology fellow and one general radiologist) evaluated two randomized series (one series included only frontal, and the other series, frontal and lateral radiographs). Likert scale of 1–5 was used to score for detection of metaphyseal and diaphyseal fractures.

Results

For combined readers, significantly more metaphyseal fractures (P = 0.01) were detected with the two-views series of radiographs compared with the frontal-only view; there was no significant difference for diaphyseal fractures. Confidence was also significantly higher for the two-views series. Kappa improved (from 0.32 to 0.48) when the lateral view was added only for the metaphyseal fractures.

Conclusion

Adding lateral radiographs resulted in increased detection and confidence levels of metaphyseal fractures.

Keywords

Child abuse Fracture ACR guidelines Skeletal survey 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Boaz Karmazyn
    • 1
  • Ryan D. Duhn
    • 2
  • S. Gregory Jennings
    • 3
  • Matthew R. Wanner
    • 1
  • Bilal Tahir
    • 3
  • Roberta Hibbard
    • 4
  • Ralph Hicks
    • 4
  1. 1.Department of Radiology and Imaging Sciences, Riley Hospital for ChildrenIndiana University School of MedicineIndianapolisUSA
  2. 2.Kalamazoo DivisionAdvanced Radiology ServicesKalamazooUSA
  3. 3.Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisUSA
  4. 4.Department of Pediatrics, Section of Child Protection ProgramsIndiana University School of MedicineIndianapolisUSA

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