An audit of skeletal surveys for suspected non-accidental injury following publication of the British Society of Paediatric Radiology guidelines

Swinson, Sophie; Tapp, Marion; Brindley, Roger; Chapman, Stephen; Offiah, A.C.; Johnson, Kirsten

doi:10.1016/j.crad.2007.11.010

Cited by 26 publications

(21 citation statements)

References 7 publications

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“…At our institution, we add bilateral oblique views of the ribs, which are invaluable for detecting frequently subtle rib fractures (Fig. 1) [23, 64]. Every effort should be made to obtain optimal images at the initial presentation.…”

Section: Radiographic Imagingmentioning

confidence: 99%

The Radiographic Approach to Child Abuse

Dwek

2011

Clinical Orthopaedics &Amp; Related Research

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BackgroundOsseous injuries are a major facet of child abuse and in most patients radiographic imaging plays a major role in diagnosis. While some injuries are typically produced as a result of excessive and inappropriate force other injuries are nonspecific in terms of their causation, but become suspicious when the history provided by the caretakers is inconsistent with the type of injury produced.Questions/purposesI detail the radiographic imaging of the more characteristic of the highly specific injuries, discuss the major issues that relate to some moderate- or low-specificity injuries, and describe several diseases that mimic abuse.MethodsA review of the current and recent literature focused on the radiographic imaging of child abuse was performed by searching the National Library of Medicine database at pubmed.gov. Keywords used included: radiology, fracture, child abuse, and/or nonaccidental trauma.ResultsInjuries that are highly specific for the diagnosis of abuse include metaphyseal corner fractures, posteromedial rib fractures, and sternal, scapular, and spinous process fractures. Lesions of moderate specificity include, among other injuries, multiple fractures of various ages and epiphyseal separations. Long-bone fractures and clavicular fractures, while common, are of low specificity. In addition to the appropriate accurate diagnosis of these injuries, several diseases and syndromes may mimic abuse due to the similarity in the radiographic picture.ConclusionsStratification of fractures sustained in child abuse according to specificity and an understanding of the several diseases that mimic abuse are helpful in the accurate diagnosis of child abuse.Level of EvidenceLevel V, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Section: Radiographic Imagingmentioning

confidence: 99%

The Radiographic Approach to Child Abuse

Dwek

2011

Clinical Orthopaedics &Amp; Related Research

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“…Alarmingly, the cervical spine was imaged infrequently in a recent audit of skeletal surveys in the United Kingdom. 60 Despite its high prognostic significance for abuse, it may be easily overlooked in concomitant head injury or polytrauma. Digital injuries are also reported in abuse, caused by squeezing, crush or forced hyperextension.…”

Section: Skeletal Injurymentioning

confidence: 99%

Orthopaedic aspects of paediatric non-accidental injury

Jayakumar

Barry

Ramachandran

2010

The Journal of Bone and Joint Surgery. British volume

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Non-accidental injury (NAI) in children includes orthopaedic trauma throughout the skeleton. Fractures with soft-tissue injuries constitute the majority of manifestations of physical abuse in children. Fracture and injury patterns vary with age and development, and NAI is intrinsically related to the mobility of the child. No fracture in isolation is pathognomonic of NAI, but specific abuse-related injuries include multiple fractures, particularly at various stages of healing, metaphyseal corner and bucket-handle fractures and fractures of ribs. Isolated or multiple rib fractures, irrespective of location, have the highest specificity for NAI. Other fractures with a high specificity for abuse include those of the scapula, lateral end of the clavicle, vertebrae and complex skull fractures. Injuries caused by NAI constitute a relatively small proportion of childhood fractures. They may be associated with significant physical and psychological morbidity, with wide- ranging effects from deviations in normal developmental progression to death. Orthopaedic surgeons must systematically assess, recognise and act on the indicators for NAI in conjunction with the paediatric multidisciplinary team.

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“…Confirming an absence of fractures may be just as useful as the presence of, for example, classic corner metaphyseal lesions, and as a result the routine use of skeletal surveys is mandatory in all cases of sudden unexpected pediatric death. Although increased coherence is needed with full skeletal survey protocols [4][5][6][7][8], this practice is largely performed well and continues to provide useful information to the medicolegal services.…”

Section: Introductionmentioning

confidence: 96%