The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: Should practice guidelines change?

Boaz Karmazyn, Max E. Lewis, S. Gregory Jennings, Roberta A. Hibbard, Ralph A. Hicks

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE. The objective of our study was to evaluate the prevalence and site of fractures detected on skeletal surveys performed for suspected child abuse at a tertiary children's hospital and to determine whether any survey images may be eliminated without affecting clinical care or the ability to make a diagnosis. MATERIALS AND METHODS. We identified all skeletal surveys performed for suspected abuse from 2003 to 2009 of children younger than 2 years. Repeated studies were excluded, as were studies not performed to evaluate for suspected abuse. From the reports, we documented the sites of all the fractures. RESULTS. Nine hundred thirty children (515 boys and 415 girls) with a median age of 6 months met the entry criteria for the study. Fractures were detected in 317 children (34%), of whom 166 (18%) had multiple fractures. The most common sites for fractures were the long bones (21%), ribs (10%), skull (7%), and clavicle (2%). Ten children (1%) had fractures in the spine (n = 3), pelvis (n = 1), hands (n = 6), and feet (n = 2). All 10 children had other signs of physical abuse. CONCLUSION. In skeletal surveys performed for suspected child abuse, fractures limited to sites other than the long bones, ribs, skull, and clavicles are rare. The additional radiation exposure and cost of obtaining radiographs of the spine, pelvis, hands, and feet may outweigh their potential benefit. Given the rarity of fractures of the spine, pelvis, hands, and feet, consideration may be given to eliminating those views from routine skeletal surveys performed to evaluate for suspected child abuse.

Original languageEnglish (US)
Pages (from-to)W159-W163
JournalAmerican Journal of Roentgenology
Volume197
Issue number1
DOIs
StatePublished - Jul 1 2011

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Keywords

  • Child abuse
  • Fractures
  • Guidelines
  • Pediatric imaging
  • Skeletal surveys

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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