1
|
Dargel S, Stenzel M, Stöver B, Schleußner E, Wittschieber D, Banaschak S, Mentzel HJ. [Guideline adherence and quality assurance in radiological diagnostics in cases of suspected child abuse in Germany]. Radiologe 2021; 61:947-954. [PMID: 34213624 PMCID: PMC8481184 DOI: 10.1007/s00117-021-00872-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND Diagnostic imaging plays a key role in the evaluation of non-accidental consequences of injuries in childhood. Fractures are the second most common consequence of child abuse, after skin lesions such as abrasions or bleeding. With the evidence of radiological criteria, non-accidental fractures can be differentiated from accidental fractures. Special types of fractures such as the classic metaphyseal lesion can only be differentiated if the image quality is high. AIM The goal of this prospective study was to assess adherence to guidelines and quality assurance of radiological diagnostics in the event of suspected abuse in Germany. For this purpose, the quantity and diagnostic quality in university and non-university hospitals as well as the existence of a pediatric radiology department were analyzed. MATERIALS AND METHODS In all, 958 X‑ray examinations of 114 suspected abuse cases (46 girls, 68 boys) were evaluated; 42 cases from university, 42 from maximum care and 30 from regular care clinics with a median age of 6 months (3 weeks-3 years of age) were assessed as DICOM data by 3 pediatric radiologists in a consensus procedure with regard to adherence to guidelines and various quality parameters. An accompanying questionnaire was used to compare the theoretical knowledge with the respective practical implementation. RESULTS A mean of 8.4 X‑rays (range 1-22) were made per case. In 12 of 114 assessed cases (10%) there was a complete skeletal status according to the S1 guideline. A babygram was performed in 13 cases (10.5%). Departments with focus on pediatric radiology produced significantly more X‑rays per skeletal status than facilities without this specialization (p < 0.04). Significantly higher qualitative implementation was recorded in university hospitals (p < 0.001). Regardless of the type of institution, there was only marginal agreement between the questionnaire response and the available image material. CONCLUSION In Germany, a guideline-compliant procedure in the event of suspected child abuse is largely lacking. It remains to be seen whether this will change in the future with the broader implementation of child protection groups and the S3+ child protection guideline adopted in 2019 (AWMF register 027-069). The establishment of reference centers for a second diagnosis and recommendations for imaging technology can also improve the quality of care over the long term.
Collapse
Affiliation(s)
- Susanne Dargel
- Sektion Kinderradiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum, Am Klinikum 1, 07747, Jena, Deutschland.
- Klinik für Geburtsmedizin, Department für Frauenheilkunde und Geburtsmedizin, Universitätsklinikum, Jena, Deutschland.
| | - Martin Stenzel
- Abteilung für Kinderradiologie, Kliniken Köln gGmbH, Kinderkrankenhaus Amsterdamer Straße, Köln, Deutschland
| | - Brigitte Stöver
- em. Abteilung Pädiatrische Radiologie, Charité Universitätsmedizin, Berlin, Deutschland
| | - Ekkehard Schleußner
- Klinik für Geburtsmedizin, Department für Frauenheilkunde und Geburtsmedizin, Universitätsklinikum, Jena, Deutschland
| | | | | | - Hans-Joachim Mentzel
- Sektion Kinderradiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum, Am Klinikum 1, 07747, Jena, Deutschland.
| |
Collapse
|
2
|
Compliance With Skeletal Surveys for Child Abuse in General Hospitals: A Statewide Quality Improvement Process. AJR Am J Roentgenol 2019; 212:976-981. [PMID: 30860887 DOI: 10.2214/ajr.18.20701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE. The purpose of this study is to perform a statewide quality improvement process to improve compliance with the American College of Radiology (ACR) guidelines in performing skeletal surveys for suspected child abuse. SUBJECTS AND METHODS. We prospectively identified all outside hospital skeletal surveys for suspected child abuse in children younger than 3 years referred to our tertiary children's hospital in 2016-2017. We included a 3-month baseline and 21-month intervention period. The quality improvement process was based on sending educational material to all ACR member radiologists in the state and making telephone calls to radiology technologist team leaders whenever the surveys were not compliant, followed by e-mails with guidance on performing skeletal surveys. We documented the views obtained and compared them with the ACR guidelines. The percentage of compliance with each individual view was assessed with the chi-square test. The total number of compliant views per survey was evaluated with ANOVA. RESULTS. Two hundred twenty-seven patients (105 female) with a mean age of 0.8 year (SD, 0.67 year; range, 0.01-3 years) were evaluated. These 227 surveys (baseline, n = 27; postintervention, n = 200) were performed at 69 different outside hospitals. Compliance significantly (p = 0.006) improved from 25.9% (7/27) during baseline to 54.0% (108/200) after intervention. There was a nonsignificant trend of improved compliance between the first (51.9%; 41/79) and last 7-month (62.3%; 33/53) periods of intervention. Among individual views, only rib oblique views showed significantly (p = 0.02) improved compliance after the intervention, from 51.9% (14/27) to 73.5% (147/200). CONCLUSION. The compliance rate with ACR guidelines for skeletal surveys in suspected child abuse at outside general hospitals significantly increased after implementation of a quality improvement process.
Collapse
|
3
|
The added value of a second read by pediatric radiologists for outside skeletal surveys. Pediatr Radiol 2019; 49:203-209. [PMID: 30367201 DOI: 10.1007/s00247-018-4276-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/28/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Fractures are the second most common finding in non-accidental trauma after cutaneous signs. Interpreting skeletal surveys could be challenging as some fractures are subtle and due to anatomical variations that can mimic injuries. OBJECTIVE To determine the effect of a second read by a pediatric radiologist of skeletal surveys for suspected non-accidental trauma initially read at referring hospitals by general radiologists. MATERIALS AND METHODS In 2016 and 2017, we identified all patients referred to our children's hospital with previous surveys performed and read at a community hospital by an outside radiologist. We excluded patients older than 3 years and studies performed at a children's hospital. The surveys were reviewed by a pediatric radiologist with the printed outside report available. Surveys with disagreement between outside read and pediatric radiologist read were reviewed by a second pediatric radiologist. A disagreement in the second read included only definite discrepant findings agreed upon by both pediatric radiologists. The Fisher exact test was performed to compare the ratio of discrepancies between readers in normal and abnormal surveys. RESULTS Two hundred twenty-five surveys were performed (120 male) at 62 referring hospitals, with a mean patient age of 10.5 months (range: 5 days-3 years). The outside read identified fractures in 104/225 (46.2%) surveys. Thirty-seven of the 225 (16.4%) contained discrepancies in interpretation (n=111). Most of these disagreements (29/37, 78.4%) resulted in a significant change in the report. There was a significant (P<0.0001) difference between disagreement rate in outside read negative (4/111, 3.2%) and positive surveys (34/104, 31.7%). The second read identified additional fractures in 22/225 (9.8%) of the surveys and disagreed with first-read fractures in 17/256 (7.6%). Four of 19 (21.1%) classic metaphyseal lesions diagnosed by the outside read were normal variants; 18 classic metaphyseal lesions were missed by the outside read. CONCLUSIONS This study supports second reads by pediatric radiologists of skeletal surveys for non-accidental trauma.
Collapse
|
4
|
Bildgebende Diagnostik bei Kindesmisshandlung. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-017-0258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
5
|
Karmazyn B, Miller EM, Lay SE, Massey JM, Wanner MR, Marine MB, Jennings SG, Ouyang F, Hibbard RA. Double-read of skeletal surveys in suspected non-accidental trauma: what we learned. Pediatr Radiol 2017; 47:584-589. [PMID: 28236132 DOI: 10.1007/s00247-017-3783-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/27/2016] [Accepted: 01/25/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Missing a fracture in a child on skeletal surveys for suspected non-accidental trauma can have devastating results. Double-read has the potential to improve fracture detection. However the yield of double-read is unknown. OBJECTIVE To determine the advantage of double-read versus single-read of radiographic skeletal surveys for suspected non-accidental trauma. MATERIALS AND METHODS The study was performed in two phases. In the first phase (April 2013 to September 2013), double-read was performed for all skeletal surveys obtained during weekday working hours. Because we had no new double-read findings in studies initially read as negative, we conducted a second phase (January 2014 to March 2014). In the second phase we limited double-reads to skeletal surveys found positive on the first read. At the end of this period, we retrospectively performed double-read for all initially negative skeletal surveys. We excluded follow-up skeletal surveys. The difference in discrepancy (new fracture or false diagnosis of a fracture) ratio between negative and positive skeletal surveys was evaluated using the Fisher exact test, and change in discrepancy ratio between the first and second study phases was evaluated using the stratified Cochran-Mantel-Haenszel test. RESULTS Overall in the two phases, 178 skeletal surveys were performed in 178 children (67 girls) with mean age of 9 months (range 3 days to 3.7 years). Double-read found 16 discrepancies in 8/178 (4.5%) skeletal surveys. Seven of these studies showed additional fractures (n=15). In one study, an initial read of a skull fracture was read as a variant on the second read. There was a significant (P=0.01) difference between rate of disagreement in negative skeletal surveys (1/104, 1.0%) and positive skeletal surveys (7/74, 9.5%). No significant change in disagreement rate was demonstrated between the two phases of the study (P=0.59). CONCLUSION Double-read of skeletal survey for suspected non-accidental trauma found false-negative fractures in a few cases and rarely found false-positive diagnosis of a fracture. Double-read uncommonly found discrepancies in an initially normal skeletal survey. Limiting double-read to initially positive studies improves the yield of the double-read.
Collapse
Affiliation(s)
- Boaz Karmazyn
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Room 1053, Indianapolis, IN, 46202, USA.
| | - Elise M Miller
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sara E Lay
- Methodist Hospital, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James M Massey
- Department of Imaging, The Children's Hospital at TriStar Centennial, Nashville, TN, USA
| | - Matthew R Wanner
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Room 1053, Indianapolis, IN, 46202, USA
| | - Megan B Marine
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Room 1053, Indianapolis, IN, 46202, USA
| | - S Gregory Jennings
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Roberta A Hibbard
- Department of Pediatrics, Section of Child Protection Programs, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
6
|
Weldon J, Price R. Skeletal survey quality in non-accidental injury – A single site evaluation of the effects of imaging checklists. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Should bone scintigraphy be used as a routine adjunct to skeletal survey in the imaging of non-accidental injury? A 10 year review of reports in a single centre. Clin Radiol 2015; 70:e83-9. [DOI: 10.1016/j.crad.2015.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 03/30/2015] [Accepted: 04/13/2015] [Indexed: 11/20/2022]
|
8
|
|
9
|
Phillips KL, Bastin ST, Davies-Payne D, Browne D, Bird HL, Craw S, Duncan D, Depree P, Leigh A, McLaughlin A, Metcalfe R, Murdoch J, Pearce K, Perry D, Thomas I, Thomson GD, Vogel S, Wilson F, Teele RL. Radiographic skeletal survey for non-accidental injury: Systematic review and development of a national New Zealand protocol. J Med Imaging Radiat Oncol 2015; 59:54-65. [DOI: 10.1111/1754-9485.12271] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/20/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Karin L. Phillips
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Sonja T. Bastin
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - David Davies-Payne
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Diana Browne
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Helen L. Bird
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Susan Craw
- Department of Radiology; Dunedin Hospital; Dunedin New Zealand
| | - David Duncan
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Philippa Depree
- Department of Radiology; Christchurch Hospital; Christchurch New Zealand
| | - Alina Leigh
- Fulford Radiology; Taranaki Base Hospital; New Plymouth New Zealand
| | - Andrew McLaughlin
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
- Department of Radiology; Middlemore Hospital; Auckland New Zealand
| | - Russell Metcalfe
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Jean Murdoch
- Department of Radiology; Capital and Coast District Health Board; Wellington New Zealand
| | - Kirsten Pearce
- Department of Radiology; Waitemata District Health Board; Auckland New Zealand
| | - David Perry
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Iona Thomas
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Glen D. Thomson
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Sally Vogel
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Francessa Wilson
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
| | - Rita L. Teele
- Department of Paediatric Radiology; Starship Children's Hospital; Auckland New Zealand
- University of Auckland School of Medicine; Auckland New Zealand
| |
Collapse
|
10
|
An analysis of survey reporting in the imaging professions: Is the issue of non-response bias being adequately addressed? Radiography (Lond) 2013. [DOI: 10.1016/j.radi.2013.02.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
11
|
Post-mortem skeletal surveys in suspected non-accidental injury. Clin Radiol 2012; 67:868-76. [DOI: 10.1016/j.crad.2012.01.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/15/2012] [Accepted: 01/25/2012] [Indexed: 11/22/2022]
|
12
|
Halliday KE, Broderick NJ, Somers JM, Hawkes R. Dating fractures in infants. Clin Radiol 2011; 66:1049-54. [PMID: 21763645 DOI: 10.1016/j.crad.2011.06.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/20/2011] [Accepted: 06/06/2011] [Indexed: 11/29/2022]
Abstract
AIM To document the timing of the appearance of the radiological features of fracture healing in a group of infants in which the date of injury was known and to assess the degree of interobserver agreement. MATERIALS AND METHODS Three paediatric radiologists independently assessed 161 images of 37 long bone fractures in 31 patients aged 0-44 months. The following features were assessed: soft-tissue swelling, subperiosteal new bone formation (SPNBF), definition of fracture line, presence or absence of callus, whether callus was well or ill defined, and the presence of endosteal callus. RESULTS Agreement between observers was only moderate for all discriminators except SPNBF. SPNBF was invariably seen after 11 days but was uncommon before this time even in the very young. In one case SPNBF was seen at 4 days. CONCLUSION With the exception of SPNBF, the criteria relied on to date fractures are either not reproducible or are poor discriminators of fracture age.
Collapse
Affiliation(s)
- K E Halliday
- Department of Radiology, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK.
| | | | | | | |
Collapse
|
13
|
A United Kingdom based survey of clinical practice in the diagnosis of suspected pulmonary embolism. Nucl Med Commun 2010; 31:112-20. [PMID: 19898262 DOI: 10.1097/mnm.0b013e3283304a29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
van Rijn R, Kieviet N, Hoekstra R, Nijs H, Bilo R. Radiology in suspected non-accidental injury: Theory and practice in the Netherlands. Eur J Radiol 2009; 71:147-51. [DOI: 10.1016/j.ejrad.2008.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 02/13/2008] [Accepted: 02/15/2008] [Indexed: 11/26/2022]
|
15
|
Kemp AM, Butler A, Morris S, Mann M, Kemp KW, Rolfe K, Sibert JR, Maguire S. Which radiological investigations should be performed to identify fractures in suspected child abuse? Clin Radiol 2006; 61:723-36. [PMID: 16905379 DOI: 10.1016/j.crad.2006.03.017] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 03/22/2006] [Accepted: 03/28/2006] [Indexed: 11/24/2022]
Abstract
AIMS To determine which radiological investigations should be performed and which children should be investigated. MATERIALS AND METHODS An all language literature search of original articles; from 1950-October 2005. Two reviewers independently reviewed each article. A third was carried out on disagreement. Each study was assessed using standardised data extraction, critical appraisal and evidence forms. RESULTS Thirty-four studies were included. Fifteen addressed the question: which investigation has a higher yield, skeletal surveys (SS) or bone scintigraphy (BS)? Studies gave conflicting results. Overall neither investigation is as good as the two combined. BS predominately missed skull, metaphyseal and epiphyseal fractures, whereas SS commonly missed rib fractures. Two studies showed that a repeat SS 2 weeks after the initial study provided significant additional information about tentative findings, the number and age of fractures. A comparative study evaluated additional oblique views of ribs in 73 children and showed improved diagnostic sensitivity, specificity and accuracy. Four studies addressed the diagnostic yield for occult fractures with respect to age. This was significant for children under 2-years old. CONCLUSIONS In children under 2-years old, where physical abuse is suspected, diagnostic imaging of the skeleton should be mandatory. SS or BS alone is inadequate to identify all fractures. It is recommended that all SS should include oblique views of the ribs. This review suggests that the following options would optimize the diagnostic yield. However, each needs to be evaluated prospectively: SS that includes oblique views, SS and BS, a SS with repeat SS or selected images 2 weeks later or a BS plus skull radiography and coned views of metaphyses and epiphyses.
Collapse
Affiliation(s)
- A M Kemp
- Welsh Child Protection Systematic Review Group, Department of Child Health, Cardiff University, UK.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Anilkumar A, Fender LJ, Broderick NJ, Somers JM, Halliday KE. The role of the follow-up chest radiograph in suspected non-accidental injury. Pediatr Radiol 2006; 36:216-8. [PMID: 16416103 DOI: 10.1007/s00247-005-0054-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 10/21/2005] [Accepted: 10/23/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Rib fractures in children under the age of 2 years have a strong correlation with non-accidental injury (NAI). Follow-up radiographs can improve detection. OBJECTIVE To evaluate the value of the follow-up chest radiograph in suspected non-accidental injury. MATERIALS AND METHODS The study included all children less than 2 years of age who were investigated for suspected NAI in our institution between January 1998 and October 2003. Prior to January 2000, only selected patients were asked to attend for a follow-up chest radiograph. From January 2000 onwards all children were asked to reattend. RESULTS Of 200 children included in the study, 59 (29.5%) reattended for a follow-up chest radiograph. The follow-up film provided useful additional information in 7 (12%) of the 59 children. In two children rib fractures were noted only on the follow-up chest radiograph. In a further two patients additional rib fractures were noted. Additional dating information was obtained for two patients. For one child both additional fractures and dating information were noted. CONCLUSIONS The follow-up chest radiograph provides useful information in children with suspected NAI and it is recommended that it should be included routinely in the imaging investigations of these children.
Collapse
Affiliation(s)
- Adikesavalu Anilkumar
- Department of Radiology, Queen's Medical Centre, Nottingham University Hospital NHS Trust, Derby Road, Nottingham NG7 2UH, UK
| | | | | | | | | |
Collapse
|
17
|
Day F, Clegg S, McPhillips M, Mok J. A retrospective case series of skeletal surveys in children with suspected non-accidental injury. ACTA ACUST UNITED AC 2006; 13:55-9. [PMID: 16464629 DOI: 10.1016/j.jcfm.2005.08.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The skeletal survey is widely used as the principal radiological investigation in suspected physical abuse of infants and young children. However, the evidence on which current guidelines are based is limited, especially for siblings of index cases. We conducted a retrospective study to describe the characteristics of children who underwent skeletal surveys for suspected non-accidental injury (NAI) in the Edinburgh area; to evaluate the diagnostic efficacy of skeletal surveys; and to identify any predictive factors that might guide clinical practice. METHODS All skeletal surveys performed at the Royal Hospital for Sick Children in Edinburgh for suspected non-accidental injury between 1/1/99 and 31/12/03 were reviewed. RESULTS Seventy-seven children underwent skeletal surveys for suspected NAI. Data were available for 76 (70 index cases and 6 siblings). Of the index cases, 17 (24%) skeletal surveys were positive, with a mean of 2.5 fractures per child (range 0-9). The age of positive cases ranged from 2 weeks to 36 months with the majority (14, 82%) being under 12 months of age. Nine (53%) were boys. In index children with positive results, indications for skeletal survey were head injury (skull fracture in 2, 12%; intracranial injury in 4,24%); skeletal fracture (excluding skull fracture) in 6 (35%) and bruising in 4 (24%). chi(2) analysis revealed no significant differences in age, sex or primary reason for skeletal survey between those with a negative and positive skeletal survey. Six skeletal surveys were performed on siblings of children with known or suspected NAI. The siblings' ages ranged from 1 to 36 months although 3 (50%) were under 12 months of age. One (17%) of the siblings' surveys (a twin) was positive. CONCLUSION The age of a child (<12 months) and type of presenting injury (overt fracture or head injury) are factors which can help the clinician to decide whether or not to obtain a skeletal survey. There remains a lack of evidence for the effectiveness of skeletal survey in the siblings of index children. Guidelines for the process of repeating uncertain skeletal surveys are needed.
Collapse
Affiliation(s)
- Fiona Day
- Department of Community Child Health, Royal Hospital for Sick Children, 10 Chalmers Crescent, Edinburgh EH9 1TS, Scotland
| | | | | | | |
Collapse
|
18
|
|
19
|
Carty H. Commentary on: A survey of non-accidental injury imaging in England, Scotland and Wales and Observational study of skeletal surveys in suspected non-accidental injury. Clin Radiol 2003; 58:694-5. [PMID: 12943640 DOI: 10.1016/s0009-9260(03)00227-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- H Carty
- Royal Liverpool Children's Hospital NHS Trust, Alder Hey, Liverpool, UK.
| |
Collapse
|