Three-dimensional skull models as a problem-solving tool in suspected child abuse

Abstract

The value of 3-D skull models in evaluation of young children with suspected child abuse is not known. The purpose of this study was to assess the value of 3-D skull models as a problem-solving tool in children younger than 2years. We performed a retrospective study on 73 children (ages 0-24months) seen by a child protection team (CPT) who were undergoing head CT between August 2007 and July 2009. Of the 73 children, volume-rendered 3-D models were obtained in 26 (35.6%). Three-dimensional models changed initial CT interpretation in nine instances (34.6%). Findings thought to be fractures were confirmed as normal variants in four children. Depressed fractures were correctly shown to be ping-pong fractures in two cases. In one case, an uncertain finding was confirmed as a fracture, and an additional contralateral fracture was identified in one child. A fracture seen on skull radiographs but not seen on axial CT images was identified on the 3-D model in one case. Changes in interpretation led to modification in management in five children. Use of 3-D skull models can be a problem-solving tool when there is discordance among the CT reading, subsequent radiographic investigations and clinical evaluation.