Abstract
Background
Skeletal surveys for non-accidental trauma (NAT) include lateral spinal and pelvic views, which have a significant radiation dose.
Objective
To determine whether pelvic and lateral spinal radiographs should routinely be performed during initial bone surveys for suspected NAT.
Materials and methods
The radiology database was queried for the period May 2005 to May 2011 using CPT codes for skeletal surveys for suspected NAT. Studies performed for skeletal dysplasia and follow-up surveys were excluded. Initial skeletal surveys were reviewed to identify fractures present, including those identified only on lateral spinal and/or pelvic radiographs. Clinical information and MR imaging was reviewed for the single patient with vertebral compression deformities.
Results
Of the 530 children, 223 (42.1%) had rib and extremity fractures suspicious for NAT. No fractures were identified solely on pelvic radiographs. Only one child (<0.2%) had vertebral compression deformities identified on a lateral spinal radiograph. This infant had rib and extremity fractures and was clinically paraplegic. MR imaging confirmed the vertebral body fractures.
Conclusion
Since no fractures were identified solely on pelvic radiographs and on lateral spinal radiographs in children without evidence of NAT, nor in nearly all with evidence of NAT, inclusion of these views in the initial evaluation of children for suspected NAT may not be warranted.
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References
Mulpuri K, Slobogean BL, Tredwell SJ (2011) The epidemiology of nonaccidental trauma in children. Clin Orthop Relat Res 469:759–767
Huang MI, O’Riordan MA, Fitzenrider E et al (2011) Increased incidence of nonaccidental head trauma in infants associated with the economic recession. J Neurosurg Pediatr 8:171–176
Meyer JS, Gunderman R, Coley BD et al (2011) ACR Appropriateness Criteria((R)) on suspected physical abuse-child. J Am Coll Radiol 8:87–94
Don S (2004) Radiosensitivity of children: potential for overexposure in CR and DR and magnitude of doses in ordinary radiographic examinations. Pediatr Radiol 34:S167–S172, discussion S234-241
Mazonakis M, Damilakis J, Raissaki M et al (2004) Radiation dose and cancer risk to children undergoing skull radiography. Pediatr Radiol 34:624–629
Frantzen MJ, Robben S, Postma AA et al (2012) Gonad shielding in paediatric pelvic radiography: disadvantages prevail over benefit. Insights Imaging 3:23–32
Almen AJ, Mattsson S (1996) Dose distribution at radiographic examination of the spine in pediatric radiology. Spine (Phila Pa 1976) 21:750–756
Huda W, Gkanatsios NA, Botash RJ et al (2002) Pediatric effective doses in diagnostic radiology. Available via http://nersp.osg.ufl.edu/∼nikos/Downloads/COMP98.pdf. Accessed 9 Jan 2013
van Rijn RR, Sieswerda-Hoogendoorn T (2012) Educational paper: imaging child abuse: the bare bones. Eur J Pediatr 171:215–224
Bennett BL, Chua MS, Care M et al (2011) Retrospective review to determine the utility of follow-up skeletal surveys in child abuse evaluations when the initial skeletal survey is normal. BMC Res Notes 4:354
Kleinman PK, Nimkin K, Spevak MR et al (1996) Follow-up skeletal surveys in suspected child abuse. AJR Am J Roentgenol 167:893–896
Karmazyn B, Lewis ME, Jennings SG et al (2011) The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change? AJR Am J Roentgenol 197:W159–W163
Sonik A, Stein-Wexler R, Rogers KK et al (2010) Follow-up skeletal surveys for suspected non-accidental trauma: can a more limited survey be performed without compromising diagnostic information? Child Abuse Negl 34:804–806
Sieswerda-Hoogendoorn T, Boos S, Spivack B et al (2012) Abusive head trauma part II: radiological aspects. Eur J Pediatr 171:617–623
Johnson K, Chapman S, Hall CM (2004) Skeletal injuries associated with sexual abuse. Pediatr Radiol 34:620–623
Ablin DS, Greenspan A, Reinhart MA (1992) Pelvic injuries in child abuse. Pediatr Radiol 22:454–457
Sink EL, Hyman JE, Matheny T et al (2011) Child abuse: the role of the orthopaedic surgeon in nonaccidental trauma. Clin Orthop Relat Res 469:790–797
Acknowledgments
Statistical support for this publication was made possible by grant number UL1 RR024146 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp
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Jha, P., Stein-Wexler, R., Coulter, K. et al. Optimizing bone surveys performed for suspected non-accidental trauma with attention to maximizing diagnostic yield while minimizing radiation exposure: utility of pelvic and lateral radiographs. Pediatr Radiol 43, 668–672 (2013). https://doi.org/10.1007/s00247-012-2614-9
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DOI: https://doi.org/10.1007/s00247-012-2614-9