Follow-Up Skeleton Surveys for Suspected Non-Accidental Trauma: Can a More Limited Survey be Performed Without Compromising Diagnostic Information?

• NCJ Number: 232730
• Journal: Child Abuse & Neglect Volume: 34 Issue: 10 Dated: October 2010 Pages: 804-806
• Author(s): Arvind Sonik; Rebecca Stein-Wexler; Kristen K. Rogers; Kevin P. Coulter; Sandra L. Wootton-Gorges
• Date Published: October 2010
• Length: 3 pages
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America

Annotation

This study determined whether certain radiographs in skeletal surveys intended to detect fractures in suspected cases of nonaccidental trauma (NAT) can be excluded without compromising clinical efficacy, since such skeletal surveys are often performed on infants and children, who constitute a particularly radiosensitive population.

Abstract

The study concluded that if no injury is detected or suspected in the pelvis, spine, hands, or skull at the initial bone survey for suspected NAT, a limited follow-up skeletal survey that excludes the pelvis, lateral spine, hands, and skull should be considered, so as to limit radiation exposure without limiting diagnostic information. A total of 36 fractures were found on the initial boney survey in 16 of 22 patients (73 percent). Six patients had no fractures detected at the initial survey; follow-up bone surveys demonstrated an additional three fractures (two extremities and one rib) in three cases (14 percent); one was in a patient whose initial survey was negative. No additional fractures in the skull, spine, pelvis, feet, or hands were detected in any case. In combination with patients reported in the literature (194 patients in total) no new fracture of the skull, spine, pelvis or hands was detected at a follow-up survey. The skull, spine, and pelvis radiographs are the highest dose-exposure studies of the skeletal survey. This retrospective study included 22 cases of suspected NAT (average age of 3.8 months) in which patients received both initial and follow-up bone surveys. The follow-up survey was conducted an average of 16.7 days after the initial survey. Radiographs were reviewed by two pediatric radiologists, with discrepancies resolved by consensus. In addition these data were combined with data from all known previously published reports of follow-up skeletal surveys for NAT meta-analysis. 1 table and 12 references