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O'Hara MA, Valvano TJ, Kashyap M, Daly JC, Bachim AN, Care MM, Egge MK, Kondis JS, Lenane AM, Maddocks ABR, Metz JB, Nielsen AK, Reeder KN, Ruda MT, Segal R, Sugarman JM, Weeks K, Oral R. Understanding Bilateral Skull Fractures in Infancy: A Retrospective Multicenter Case Review. Pediatr Emerg Care 2023; 39:329-334. [PMID: 35413039 DOI: 10.1097/pec.0000000000002704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bilateral skull fractures in infancy often raise suspicion for abuse. Nevertheless, literature suggests that they may occur accidentally. However, empiric data are lacking. OBJECTIVE This multicenter retrospective review aimed to characterize bilateral skull fractures in a large sample. PARTICIPANTS AND SETTING Medical records for infants younger than 24 months with bilateral skull fractures involving hospital consultation with a child abuse pediatrician (CAP) were reviewed from 2005 to 2020 at 13 nationally represented institutions. METHODS Standardized data collection across institutions included historical features, fracture characteristics, and additional injuries, as well as the CAP's determination of accident versus abuse. Pooled data were analyzed for descriptive and bivariate analyses. RESULTS For 235 cases, 141 were accidental, and 94 abuse. The majority occurred in young infants, and a history of a fall was common in 70% of cases. More than 80% involved both parietal bones. Bilateral simple linear fractures were more common in accidental cases, 79% versus 35%, whereas a complex fracture was more frequent in abuse cases, 55% versus 21% ( P < 0.001). Almost two thirds of accidental cases showed approximation of the fractures at the sagittal suture, compared with one third of abuse cases ( P < 0.001). Whereas focal intracranial hemorrhage was seen in 43% of all cases, diffuse intracranial hemorrhage was seen more in abuse cases (45%) than accidents (11%). Skin trauma was more common in abusive than accidental injury (67% vs 17%, P < 0.001), as were additional fractures on skeletal survey (49% vs 3%, P < 0.001). CONCLUSIONS A fall history was common in bilateral skull fractures deemed accidental by a CAP. Most accidental cases involved young infants with biparietal simple linear fractures, without skin trauma or additional fractures. A skeletal survey may aid in the determination of accidental or abusive injury for unwitnessed events resulting in bilateral skull fractures in infants.
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Affiliation(s)
| | - Thomas J Valvano
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Marisha Kashyap
- Mailman School of Public Health, Columbia University, New York, NY
| | - Jennie C Daly
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA
| | - Angela N Bachim
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Marguerite M Care
- Department of Radiology and Medical Imaging, Cincinnati Children's Medical Center, Cincinnati, OH
| | - Melissa K Egge
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA
| | - Jamie S Kondis
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO
| | - Ann M Lenane
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Alexis B R Maddocks
- Department of Radiology, New York-Presbyterian Hospital, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY
| | - James B Metz
- Department of Pediatrics, University of Vermont Children's Hospital, Burlington, VT
| | - Anne K Nielsen
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Kristen N Reeder
- Department of Pediatrics, UT Southwestern Medical Center, Dallas
| | - Michelle T Ruda
- Department of Pediatrics, University of Texas Health Science Center, Houston, TX
| | - Rachel Segal
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA
| | - Jacqueline M Sugarman
- Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky, Lexington, KY
| | - Kerri Weeks
- Department of Pediatrics, Wesley Children's Hospital, Wichita, KS
| | - Resmiye Oral
- Department of Pediatrics, Children's Hospital at Dartmouth, Lebanon, NH
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Pilla NI, Nasreddine A, Christie KJ, Hennrikus WL. Rate of orthopedic resident and medical student recognition of nonaccidental trauma: a pilot study. J Pediatr Orthop B 2022; 31:407-413. [PMID: 34985011 DOI: 10.1097/bpb.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the efficacy and accuracy of mandated reporters to identify child abuse in children presenting with fractures. An Institutional Review Board approved survey-based study between January 2017 and December 2017 was conducted at a tertiary care academic medical center. 10 cases were combined to create one survey. Each case had information on presentation history, radiographic data, and social history. This study assesses the ability of 13 orthopedic residents and 11 medical students to diagnose child abuse. Participants had the option to explain their reasoning for a given case. To evaluate decision-making reasoning, we split responses into three cohorts, encompassing objective evidence, subjective evidence, or social evidence. Twenty-four participants completed the survey; 203 out of 240 (85%) included the rationale for the diagnosis of child abuse. The observed diagnostic odds ratio was 0.83 for medical students, 0.93 for junior residents, and 0.96 for senior residents. There was no statistically significant difference in diagnosing child abuse between a participant's level of experience, age, or whether participants had their own children. Participants who used more than one source of evidence were significantly more likely to make the correct diagnosis (P = 0.013). Participant decisions were no more accurate than a coin toss. The use of several data sources led to increased diagnostic accuracy. There is low accuracy in correctly diagnosing child abuse in our cohort of mandated reporters. Participants who highlighted using several sources of evidence were more likely to diagnose child abuse accurately.
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Affiliation(s)
- Nicholas I Pilla
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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3
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Panayiotou A, De La Hoz Polo M, Tang V, Haque S. Spectrum of anatomical variants, normal findings and pathology in and around the paediatric sternum. Pediatr Radiol 2022; 52:1175-1186. [PMID: 35142891 DOI: 10.1007/s00247-021-05268-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/18/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
Abnormalities of the sternum and adjacent structures are an uncommon presentation in the paediatric population and can have a variety of benign and malignant causes, including normal and developmental variants of the chest wall. Although there is overlap with adults, many sternal abnormalities are unique to the paediatric population. Following clinical examination, radiography is usually the first type of imaging used; however, it is limited and often ultrasound and cross-sectional imaging are needed for further assessment. An understanding of the normal anatomy is important; however, this can be challenging due to the varied appearances of age-related changes of the sternum. The purpose of this article is to familiarize the general paediatric radiologist with the expected anatomy and imaging findings of the developing sternum, anatomical variants and pathology of the sternum and adjacent structures encountered in this group of patients.
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Affiliation(s)
- Andreas Panayiotou
- Department of Radiology, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | | | - Vivian Tang
- Department of Radiology, Royal Manchester Children's Hospital, Manchester, UK
| | - Saira Haque
- Department of Radiology, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
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Wessels RM, Moodley H. Fatal non-accidental injury in South Africa: A Gauteng hospital’s perspective on the incidence and fracture types in post-mortem skeletal surveys. SA J Radiol 2022; 26:2311. [PMID: 35284098 PMCID: PMC8905488 DOI: 10.4102/sajr.v26i1.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022] Open
Abstract
Background In its severest form, non-accidental injury (NAI) in children is fatal. South Africa has been reported to have double the global average of child homicides. Autopsy is the main investigation in fatal NAI with post-mortem skeletal surveys (PMSS) playing an adjunctive role. Whilst fracture patterns associated with NAI in living patients have been established, this has not been investigated in PMSS in South Africa. Objectives To determine the incidence and characteristics of fractures in suspected fatal NAI cases. To calculate the incidence of fractures according to high-, moderate- and low-specificity fracture locations for NAI. Methods A retrospective review of all PMSS performed between 01 January 2012 and 03 December 2018 was conducted at the Charlotte Maxeke Johannesburg Academic Hospital. Results Of the 73 PMSS, 33 (45.2%) demonstrated fractures. No statistical significance in sex was found: 38 (52.1%) were male and 35 (47.9%) were female (p > 0.05). The mean age of those who sustained fractures was 28 months (standard deviation [s.d.]: 21 months). A total of 115 fractures were sustained, of that the top five bones fractured were the ribs 37 (32.2%), parietal bone 13 (11.3%), ulna 13 (11.3%), femur 13 (11.3%), and radius 11 (9.6%). High-specificity fracture locations accounted for 40/133 (30.1%). Conclusion The fracture types in PMSS were similar to those in live skeletal surveys. Our study’s fracture rate was higher in comparison to international studies. The PMSS is a valuable adjunct to autopsy in detecting occult fractures of the limbs. We recommend that PMSS be performed in suspected fatal NAI cases at least in children up to 24 months of age.
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Affiliation(s)
- Robyn M Wessels
- Department of Diagnostic Radiology, Faculty of Radiation Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Halvani Moodley
- Department of Diagnostic Radiology, Faculty of Radiation Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
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Uçan B, Tokur O, Aydın S. Pediatric skull fractures: could suture contact be a sign of abuse? Emerg Radiol 2022; 29:403-408. [PMID: 35044547 DOI: 10.1007/s10140-022-02024-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Skull fractures in infants and young children can occur as a result of both accidental trauma and abuse. 1/3 of children with abuse-related head trauma and 1/5 of children with abuse-related fractures were overlooked during the initial evaluation. In this study, we aim to investigate the prevalence of skull fractures that come into contact with the suture in head traumas caused by accidents and abuse, and also to see if contact of the fracture line with the suture could be used as a sign for abuse in the pediatric population. METHODS Forry-four patients with head trauma were retrospectively assessed between January 2010 and June 2020 and were confirmed to have fractures on a brain CT. Patient age, gender, and head injury type were recorded. The fracture site, location and number, the contact of the fracture line with the suture, the name, and number of the suture it came into contact with were determined. RESULTS Twenty-eight skull fractures in 22 children with a diagnosis of child abuse and 25 skull fractures in 22 children due to accidental trauma were evaluated in the same age and gender range. Eighteen (64%) of 28 abuse-related skull fractures were in contact with two or more sutures. Two (8%) of 25 accident-related fractures were related to two or more sutures. Abuse-related fractures had a significantly higher suture contact rate than accident-related fractures (p = 0.007). CONCLUSION Contact with two or more sutures of a skull fracture is a finding related to abuse rather than accident.
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Affiliation(s)
- Berna Uçan
- Department of Radiology, Dr. Sami Ulus Training and Research Hospital, Ankara, Turkey
| | - Oğuzhan Tokur
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey.
| | - Sonay Aydın
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
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Offiah AC. Current and emerging artificial intelligence applications for pediatric musculoskeletal radiology. Pediatr Radiol 2022; 52:2149-2158. [PMID: 34272573 PMCID: PMC9537230 DOI: 10.1007/s00247-021-05130-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/28/2021] [Accepted: 06/10/2021] [Indexed: 12/03/2022]
Abstract
Artificial intelligence (AI) is playing an ever-increasing role in radiology (more so in the adult world than in pediatrics), to the extent that there are unfounded fears it will completely take over the role of the radiologist. In relation to musculoskeletal applications of AI in pediatric radiology, we are far from the time when AI will replace radiologists; even for the commonest application (bone age assessment), AI is more often employed in an AI-assist mode rather than an AI-replace or AI-extend mode. AI for bone age assessment has been in clinical use for more than a decade and is the area in which most research has been conducted. Most other potential indications in children (such as appendicular and vertebral fracture detection) remain largely in the research domain. This article reviews the areas in which AI is most prominent in relation to the pediatric musculoskeletal system, briefly summarizing the current literature and highlighting areas for future research. Pediatric radiologists are encouraged to participate as members of the research teams conducting pediatric radiology artificial intelligence research.
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Affiliation(s)
- Amaka C. Offiah
- grid.11835.3e0000 0004 1936 9262Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Sheffield, S10 2TH UK ,grid.419127.80000 0004 0463 9178Department of Radiology, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
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Halligan RK, Royle L, Lloyd C, Vara R, Cheung MSM. Wormian bones: thinking beyond osteogenesis imperfecta. Arch Dis Child 2021; 106:1057. [PMID: 33419725 DOI: 10.1136/archdischild-2020-320885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | - Leanne Royle
- Paediatric Radiology, Evelina London Children's Hospital, London, UK
| | - Claire Lloyd
- Paediatric Radiology, Evelina London Children's Hospital, London, UK
| | - Roshni Vara
- Paediatric Metabolic Medicine, Evelina London Children's Hospital, London, UK
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Paediatric radiology: child abuse imaging in the national spotlight. Clin Radiol 2021; 76:631-633. [PMID: 34366080 DOI: 10.1016/j.crad.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022]
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Sidpra J, Chhabda S, Oates AJ, Bhatia A, Blaser SI, Mankad K. Abusive head trauma: neuroimaging mimics and diagnostic complexities. Pediatr Radiol 2021; 51:947-965. [PMID: 33999237 DOI: 10.1007/s00247-020-04940-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/13/2020] [Accepted: 12/16/2020] [Indexed: 12/24/2022]
Abstract
Traumatic brain injury is responsible for approximately half of all childhood deaths from infancy to puberty, the majority of which are attributable to abusive head trauma (AHT). Due to the broad way patients present and the lack of a clear mechanism of injury in some cases, neuroimaging plays an integral role in the diagnostic pathway of these children. However, this nonspecific nature also presages the existence of numerous conditions that mimic both the clinical and neuroimaging findings seen in AHT. This propensity for misdiagnosis is compounded by the lack of pathognomonic patterns and clear diagnostic criteria. The repercussions of this are severe and have a profound stigmatic effect. The authors present an exhaustive review of the literature complemented by illustrative cases from their institutions with the aim of providing a framework with which to approach the neuroimaging and diagnosis of AHT.
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Affiliation(s)
- Jai Sidpra
- University College London Medical School, London, UK
| | - Sahil Chhabda
- Department of Radiology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Adam J Oates
- Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Aashim Bhatia
- Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Susan I Blaser
- Department of Radiology, Hospital for Sick Children, Toronto, ON, Canada
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
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10
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Skull fractures in abusive head trauma: a single centre experience and review of the literature. Childs Nerv Syst 2021; 37:919-929. [PMID: 32935234 DOI: 10.1007/s00381-020-04870-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The authors provide a comprehensive framework with which to approach paediatric calvarial injury sustained as a result of suspected abusive head trauma (AHT). This is achieved through the presentation of a case series set in the context of the unique morphology of the infant skull and the possible diagnostic pitfalls which may arise due to the presence of variant anatomy or other mimicking conditions. METHODS A retrospective analysis of sixty-three patients referred to our institution with suspected AHT was carried out. Seventeen patients with skull fractures were identified and their fractures were described in terms of anatomical location, type and course. Our data was then interpreted in the light of known anatomical fracture mimics and the available literature on the subject. RESULTS Forty-two skull fractures were identified and described in our cohort, most of which were simple linear fractures of the parietal bones (33%). There were also a substantial number of complex stellate fractures, namely of the parietal (29%) and occipital (10%) bones. Eleven fracture mimics including accessory sutures and wormian bones were also identified in this cohort. CONCLUSIONS Our study supports and builds on the existing literature, thereby offering a more complete view of the spectrum of calvarial damage sustained as a result of AHT in the context of its diagnostic pitfalls.
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Lyme Disease Misinterpreted as Child Abuse. Case Rep Orthop 2021; 2021:6665935. [PMID: 33628554 PMCID: PMC7880705 DOI: 10.1155/2021/6665935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022] Open
Abstract
Child abuse is one of the most common causes for child fatality in the United States. Inaccurate reporting of child abuse combined with scarcity of resources for child abuse evaluations can lead to unintended consequences for children and their families. The differential diagnosis of child abuse is varied. To our knowledge, there are no reports in the literature on Lyme disease mimicking child abuse. The current study presents the case of a child from an endemic area for Lyme disease presenting with skin bruising, fracture, and swollen knee. The child was reported for child abuse by the pediatrician and then referred to the orthopaedic surgeon for fracture care.
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Shaw J, Simonton K. Pediatric Fractures: Identifying and Managing Physical Abuse. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Webb M, Sherman SS, Sung L, Schmidt CJ, Hlavaty L. Abusive Pediatric Thoracolumbar Fracture Due to Forced Hyperextension: Case Report, Biomechanical Considerations, and Review of the Literature. J Forensic Sci 2020; 65:2023-2029. [PMID: 32804424 DOI: 10.1111/1556-4029.14521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/20/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
Pediatric thoracolumbar fractures are rare due to the physiological differences which afford greater resilience to the immature spine. Most pediatric thoracolumbar fractures occur as the result of high energy trauma, such as motor vehicle accidents, and modes of reasonable accidental injuries are limited by age and developmental capabilities of the child. These fractures can occur as the result of inflicted blunt force trauma and child abuse, and in most cases, the mechanism of injury to the spine is not known. We report the death of a 29-month-old man due to blunt force trauma to the back and forced hyperextension of the thoracolumbar spine causing fracture of the fourth lumbar (L4) vertebral body. A complete forensic examination revealed a previous healing fracture of the anterior aspect of the L4 vertebral body, with acute disruption of the anterior longitudinal ligament overlying the fracture site, complete fracture of the vertebral body, and fatal retroperitoneal hemorrhage. We present a review of the biomechanical considerations of the pediatric spine, a survey of pediatric spinal fractures, and a review of the literature on pediatric abusive thoracolumbar fractures. In this case, there was never a provided explanation for how the injury occurred; however, understanding the biomechanics of the pediatric spine allowed for the determination of the mechanism, force required to produce this specific pattern of abusive spinal injury, and the manner of death.
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Affiliation(s)
- Milad Webb
- Wayne County Medical Examiner's Office, Michigan Medicine, 1300 Warren Avenue, Detroit, Michigan, 48207
| | | | - LokMan Sung
- Wayne County Medical Examiner's Office, Michigan Medicine, 1300 Warren Avenue, Detroit, Michigan, 48207
| | - Carl J Schmidt
- Wayne County Medical Examiner's Office, Michigan Medicine, 1300 Warren Avenue, Detroit, Michigan, 48207
| | - Leigh Hlavaty
- Wayne County Medical Examiner's Office, Michigan Medicine, 1300 Warren Avenue, Detroit, Michigan, 48207
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Paddock M, Sprigg A, Halliday K, Offiah A. Re: A comprehensive toolkit for imaging children who may have been abused: new guidance from the Royal College of Radiologists and the Society and College of Radiographers. Clin Radiol 2018; 73:672-673. [DOI: 10.1016/j.crad.2018.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 11/28/2022]
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Keeping an Open Mind: Cognitive Bias in the Evaluation of an Infant with Posterior-Lateral Rib Fractures. Case Rep Pediatr 2017; 2017:5163094. [PMID: 29214091 PMCID: PMC5682078 DOI: 10.1155/2017/5163094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/22/2017] [Accepted: 10/02/2017] [Indexed: 12/02/2022] Open
Abstract
A four-month-old former premature male is incidentally found to have posterior-lateral rib fractures during evaluation of a febrile illness. This finding led to the initiation of a workup for nonaccidental trauma. A thorough history and physical exam ultimately led to the diagnosis, which was not related to abuse. This case highlights a rare sequela of patent ductus arteriosus repair, cautions medical teams to remain aware of how cognitive bias can affect diagnostic decision-making, and emphasizes the importance of a thorough history, physical exam, and medical record review in cases of suspected nonaccidental trauma.
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An Update on Imaging in Child Abuse. J Belg Soc Radiol 2017; 101:9. [PMID: 30506027 PMCID: PMC6253022 DOI: 10.5334/jbr-btr.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Re: Imaging and reporting considerations for suspected physical abuse (non-accidental injury) in infants and young children. Part 1: initial considerations and appendicular skeleton. A reply. Clin Radiol 2017; 72:422. [PMID: 28274508 DOI: 10.1016/j.crad.2017.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 11/23/2022]
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