Retrospective review to determine the utility of follow-up skeletal surveys in child abuse evaluations when the initial skeletal survey is normal.

Berkeley L Bennett,Andrea Kachelmeyer,Michael S Chua,Marguerite Care,Melinda Mahabee-Gittens

doi:10.1186/1756-0500-4-354

Berkeley L Bennett, Andrea Kachelmeyer + Show 3 more

Open Access

https://doi.org/10.1186/1756-0500-4-354

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Abstract

ObjectiveThe AAP recommends that a follow-up skeletal survey be obtained for all children < 24 months of age who are strongly suspected to be victims of abuse. The objective of the current study was to evaluate the utility of a follow-up skeletal survey in suspected child physical abuse evaluations when the initial skeletal survey is normal.MethodsA retrospective review of radiology records from September 1, 1998 - January 31, 2007 was conducted. Suspected victims of child abuse who were < 24 months of age and received initial and follow-up skeletal surveys within 56 days were enrolled in the study. Children with a negative initial skeletal survey were included for further analysis.ResultsForty-seven children had a negative initial skeletal survey and were included for analysis. The mean age was 6.9 months (SD 5.7); the mean number of days between skeletal surveys was 18.7 (SD 10.1)Four children (8.5%) had signs of healing bone trauma on a follow-up skeletal survey. Three of these children (75%) had healing rib fractures and one child had a healing proximal humerus fracture. The findings on the follow-up skeletal survey yielded forensically important information in all 4 cases and strengthened the diagnosis of non-accidental trauma.Conclusion8.5 percent of children with negative initial skeletal surveys had forensically important findings on follow-up skeletal survey that increased the certainty of the diagnosis of non-accidental trauma. A follow-up skeletal survey can be useful even when the initial skeletal survey is negative.

Highlights

Skeletal surveys are an important part of the evaluation of young children who are suspected to be victims of non-accidental trauma and are a major part of the diagnosis of physical abuse [1]
The American Academy of Pediatrics Committee on Child Abuse and Neglect recommends that a skeletal survey be obtained for any child less than 24 months of age with suspected physical abuse [2]
This time frame was based on previous literature [6] and Cincinnati Children’s Hospital Medical Center (CCHMC) radiologist recommendations recognizing that many fractures may have completely healed after 56 days and at that time would not be detectable on radiographs

Summary

Introduction

Skeletal surveys are an important part of the evaluation of young children who are suspected to be victims of non-accidental trauma and are a major part of the diagnosis of physical abuse [1]. Kleinman et al [4], Zimmerman et al [6] and Harlan et al [7] showed that additional radiographs identified new fractures and clarified tentative findings in children with abnormalities in the initial skeletal survey. These investigations demonstrated the utility of obtaining follow-up imaging in children with abnormal initial skeletal surveys. Because a follow-up skeletal survey induces exposure to radiation, further information regarding the yield of this testing can be valuable for medical practitioners

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Discussion

Conclusion