Follow-up skeletal surveys in suspected child abuse.

TLDR

When child abuse is strongly suspected, a follow‑up skeletal survey is recommended to provide a thorough and accurate assessment of bone injuries. The study aimed to evaluate the additional diagnostic yield of a repeat skeletal survey in infants and toddlers with suspected abuse. Twenty‑three infants and toddlers underwent a repeat skeletal survey two weeks after the initial exam using a high‑detail imaging system (single‑emulsion, single‑screen with low‑absorption carbon‑fiber cassette) and a protocol of tightly collimated anteroposterior appendicular and anteroposterior/lateral axial views. The repeat survey identified 14 additional injuries (61 % of cases), increasing definite fractures from 70 to 89 (27 % increase, p = .005), mostly classic metaphyseal lesions or rib fractures, and provided age information for 13 of the 70 previously detected fractures.

Abstract

The purpose of this study was to assess the additional yield of a repeat skeletal survey in identifying and dating skeletal injury for cases in which child abuse was strongly suspected.Twenty-three infants and toddlers strongly suspected of being physically abused on the basis of findings on the initial skeletal survey, other imaging studies, history, or physical examination underwent a follow-up examination approximately 2 weeks after the initial examination. The high-detail imaging system included a single-emulsion, single-screen combination with a low-absorption carbon-fiber cassette. The skeletal survey protocol entailed tightly collimated anteroposterior views of the appendicular skeleton and anteroposterior and lateral views of the axial skeleton. Between the two studies, all children were in Department of Social Services custody or living in a safe home.The follow-up skeletal survey yielded additional information regarding skeletal injury in 14 (61%) of 23 cases. Follow-up study increased the number of definite fractures detected from 70 to 89 (27%) (p = .005). Most of these additional injuries were classic metaphyseal lesions or rib fractures. In 13 of the 70 fractures previously detected, the follow-up skeletal survey also provided important information about the age of those injuries.When child abuse is strongly suspected on the basis of the findings on the initial skeletal survey, other imaging studies, history, or physical examination, a follow-up skeletal survey is recommended to provide a through and accurate assessment of osseous injuries.