Abstract
PurposeThe purpose of the study was to determine the rate of occult fractures (without clinical symptoms) per presenting clinical injury i.e., children presenting with a fracture, bruise, abusive head trauma and the types of fracture most likely to be found, in a series of infants and young children suspected of being victims of NAT.MethodsSkeletal surveys done between 2008 and 2018 of children (< 5 years) were retrospectively analyzed. Both radiographs of admitted children and reassessment images from all over the country were included and reviewed by a forensic paediatric radiologist. Deceased children were excluded. Variables as gender, age, initial clinical injury and occult fractures were collected. Occult fractures on the follow-up skeletal survey were collected.ResultsA total of 370 skeletal surveys of 296 children were included. Median age was 22 weeks (IQR 11–48), there were 172 (58%) boys. A total of 195 occult fractures were detected in 111 (32%) children. Occult fractures were detected in 37/126 (29%) children with fracture as presenting symptom, 33/90 (37%) children with head trauma and 26/50 (52%) children with bruises. Rib (n = 56, 50%) and lower leg (n = 40, 36%) fractures were most detected.ConclusionOccult fractures were detected in 32% of the children. Occult fractures were most prevalent if the initial clinical injury suggestive for NAT to request skeletal survey was a bruise, abusive head trauma or fracture.
Highlights
IntroductionChildren who are suspected of non-accidental trauma (i.e., physical child abuse or injuries due to neglect) are usually referred and evaluated by a multidisciplinary team, the child abuse and neglect team (CAN—team)
Children who are suspected of non-accidental trauma are usually referred and evaluated by a multidisciplinary team, the child abuse and neglect team (CAN—team)
According to the guideline ‘The radiological investigation of suspected physical abuse in children’ of the Royal College of Radiologists and Society and College of Radiographers, a skeletal survey should be performed in all children younger than 2 years old when non-accidental trauma is suspected [1, 2]
Summary
Children who are suspected of non-accidental trauma (i.e., physical child abuse or injuries due to neglect) are usually referred and evaluated by a multidisciplinary team, the child abuse and neglect team (CAN—team). The CAN—team advices—in accordance with guidelines—which diagnostic tests should be used in order to identify injuries, such as a full head-to-toe examination to detect bruises and a skeletal survey to detect occult fractures (fractures without any apparent clinical symptoms). According to the guideline ‘The radiological investigation of suspected physical abuse in children’ of the Royal College of Radiologists and Society and College of Radiographers, a skeletal survey should be performed in all children younger than 2 years old when non-accidental trauma is suspected [1, 2]. An overview of the radiographs of the skeletal survey are provided in an e-supplement [1, 5]
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