Head imaging in suspected non accidental injury in the paediatric population. In the advent of volumetric CT imaging, has the skull X-ray become redundant?

A comparison of computed tomography, X‐ray and Lodox® scans in assessing pediatric skull fractures using piglets

“…In addition, the presence [4,7,8,24]. Since CT scans have the highest sensitivity for detecting fractures at the correct location, children with suspected cranial fractures should undergo CT scans where possible rather than X-rays and Lodox ® , which are insensitive and add no diagnostic value over CTs, a recommendation also made by a number of other authors [3,4,12]. Moreover, CT scans have the additional advantage of visualizing intracranial injury and trauma [5,12].…”

“…Head injuries are extremely common in young children and infants, both as a result of accidents and abuse, and often result in skull fractures [1][2][3]. It is imperative that pediatric skull fractures be accurately detected in order to determine possible cause and manner of death [3][4][5][6][7][8]. In addition, it is important that all skull fractures are detected in order to identify potential victims of abuse, since failure to do so can put them at further risk of injury and allow perpetrators to go free [9].…”

“…Some studies have assessed the diagnostic accuracy of these imaging tools in detecting fractures in pediatric patients and have found that CT scans identified more fractures than X-rays, and that many fractures identified by X-rays were false-positives [3,12].…”

“…Skull fractures are common in children, both as a result of accidental and abusive trauma[1][2][3]. The accurate detection of these fractures is critical in order to determine possible cause and manner of death[3][4][5][6][7][8]. Furthermore, as is common during forensic anthropological examinations, assessing the location and pattern of each skull fracture has implications for determining the minimum number of blows inflicted, as well as potentially distinguishing between accidental and abusive trauma.…”

A review of current imaging techniques used for the detection of occult bony fractures in young children suspected of sustaining non‐accidental injury

“…A post‐mortem study indicated 71% of skull fractures were identified on CT when compared to autopsy 84 . CT has been shown to increase the detection of skull fractures in children, identifying 10–30% more skull fractures than radiographs 49,84,89–91 . In these studies, diastatic fractures were significantly more likely to be seen by CT than radiographs, although the relative increase in detectability of linear fractures was more modest 49,84,90 .…”