Improving national standards of child protection skeletal surveys: the value of College guidance

Patel, Hiten J; Swinson, Sophie; Johnson, Kirsten

doi:10.1016/j.crad.2016.07.019

Cited by 13 publications

(12 citation statements)

References 4 publications

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“…Since the publication of the RCR‐RCPCH guidelines, a study by Patel et al, looking at 100 skeletal surveys, found that 51% of studies contained all recommended views and each view had an average quality score 97%. A retrospective evaluation by Weldon and Price, which analysed 121 NAI skeletal survey examinations, found the implementation of imaging checklists improved skeletal survey quality.…”

Section: Resultsmentioning

confidence: 99%

“…27 The content and quality of the skeletal survey should be consistent between institutions, to improve the detection and ensuring accurate reporting of the images. 6…”

Section: Conventional Radiographymentioning

confidence: 99%

“…5 The investigation of NAI requires a thorough history and clinical examination, which may be supplemented by radiological investigations, including radiographic and cross-sectional imaging. 6 Imaging in NAI remains a contentious issue, with little concordance regarding how, when and what imaging modalities should be used in the workup of the child who is suspected of having suffered abuse. 7 Failure to diagnose NAI carries significant risk for morbidity, particularly in non-ambulatory and nonverbal children.…”

Section: Introductionmentioning

confidence: 99%

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Imaging of non‐accidental injury; what is clinical best practice?

Nguyen

Hart

2018

J of Medical Radiation Sci

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Non‐accidental injury (NAI) remains the leading cause of morbidity and mortality in children. Fractures are the second most common findings of NAI, after cutaneous lesions such as bruises and contusions. Imaging in NAI remains a controversial issue with little agreement concerning how, when and what imaging modalities should be used in the investigation of suspected cases. This review addresses the radiological investigations and findings of NAI, and the differential diagnoses of these findings. Adherence to the international guidelines for skeletal survey imaging is recommended. This ensures the content and quality of the radiographic series are of an optimal standard to improve the detection of occult fractures, and ensuring the accurate reporting of images. The involvement of a paediatric radiologist is important, if not essential in the diagnosis of NAI. In the evaluation of suspected cases, the role of the radiologist includes the detection of radiological findings suggestive of NAI, and the differentiation of these findings from normal variants and underlying pathologies. The diagnosis of NAI relies not only on radiological imaging, but also a combination of clinical and social findings. It is mandatory that all physicians work in close collaboration to improve diagnostic accuracy, as failure to diagnose NAI carries significant risk for morbidity.

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Section: Resultsmentioning

confidence: 99%

“…27 The content and quality of the skeletal survey should be consistent between institutions, to improve the detection and ensuring accurate reporting of the images. 6…”

Section: Conventional Radiographymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Imaging of non‐accidental injury; what is clinical best practice?

Nguyen

Hart

2018

J of Medical Radiation Sci

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“…This follow-up period presents a temporal medicolegal challenge for the police and social services, because the child needs to be in a safe place and potential perpetrators need to be identified quickly. Together with evidence that hospitals, social workers, parents, and children adhere poorly to the schedule of follow-up radiographs,24, 25 we argue that the use of CT in the acute setting in which radiographs are negative or unequivocal will probably identify otherwise undetected rib fractures, providing immediate diagnostic information, which is preferable to waiting for follow-up radiographs. Because all infants suspected of physical abuse will undergo a head CT to look for intracranial injury as per national guidelines, 1 we argue that the addition of a subsievert chest CT during the same attendance would be pragmatic.…”

Section: Discussionmentioning

confidence: 85%

Chest radiographs versus CT for the detection of rib fractures in children (DRIFT): a diagnostic accuracy observational study

Shelmerdine

Langan

Hutchinson

et al. 2018

The Lancet Child & Adolescent Health

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SummaryBackgroundInternationally, chest radiography is the standard investigation for identifying rib fractures in suspected physical abuse in infants. Several small observation studies in children have found that chest CT can provide greater accuracy than radiography for fracture detection, potentially aiding medicolegal proceedings in abuse cases; however, to our knowledge, this greater accuracy has not been comprehensively evaluated. We aimed to determine differences in rib fracture detection rates between post-mortem chest radiographs and chest CT images, using forensic autopsy as the reference standard.MethodsIn this retrospective diagnostic accuracy study, we searched the Great Ormond Street Hospital (London, UK) radiology information system for all children aged 0–16 years who had a post-mortem skeletal survey (ie, full-body radiography), CT, and full autopsy between Jan 1, 2012, and Jan 1, 2017, for a purpose of death investigation. Cases were excluded if the imaging was done for a reason other than a forensic investigation or if image quality was suboptimal. Radiologists were recruited as reporters on a voluntary basis via membership databases from international radiology and post-mortem imaging societies with no specific inclusion or exclusion criteria. Reporters were sent a set of chest radiographs on a password protected and encrypted USB flash drive or via a secure filesharing website and independently reported on the presence of rib fractures, fracture location, and the confidence level of their interpretation. They were masked to the clinical information of the images. 1 month later, the same reporters were sent CTs for the same cases in a random order and asked to report on the same features. The primary objective was to compare the accuracy of detection of rib fractures by use of post-mortem chest radiographs and CTs, with autopsy data as reference standard. Accuracy was assessed by comparison of diagnostic statistics, calculated using random-intercept multilevel logistic models with reporter and patient included as cross-classified random-effects.Findings25 cases of children (aged 1 month to 7 years), with 136 rib fractures at autopsy with paired post-mortem chest radiographs and CTs, were selected for analysis. 38 radiologists were recruited as reporters from 23 international centres; 12 (32%) were consultants, median experience of 14·5 years (range 6–27), and 26 (68%) were registrars, median experience of 4 years (range 2–9). Across all radiologists, three times as many rib fractures were correctly detected by use of chest CTs compared with chest radiography (sensitivity 44·9% [95% CI 31·7–58·9] vs 13·5% [8·1–21·5]; difference 31·4% [23·3–37·8; p<0·001]). Sensitivity for detection on the correct rib was higher by use of CT than by use of radiography (62·4% [95% CI 44·9–77·1] vs 23·1% [12·9–37·8]; difference 39·3% [31·9–42·2; p<0·001]), as was diagnosis of a patient with any rib fracture or fractures (81·5% [75·8–86·0] vs 64·7% [57·3–71·4]; difference 16·7% [11·5–22·2; p<0·001]). Radiologist con...

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“…Therefore, eradicating this phenomenon can significantly enhance healthcare outcomes. To adequately diagnose affected children, taking a full history and full examination of the child is essential when formulating a proper decision (5). It has been demonstrated that radiological skeletal assessment is a critical tool for assessing and adequately diagnosing the physical abuse of children.…”

Section: Introductionmentioning

confidence: 99%

Importance of Radiological Skeletal Assessment for Early Detection of Child Abuse

Sait¹,

Alnefaie²,

Aljohani³

et al. 2021

JOHS

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Evidence indicates that the physical abuse of children is a significant healthcare problem in various different communities. Therefore, eradicating this phenomenon can significantly enhance healthcare outcomes. To adequately diagnose the affected children, taking a full history and full examination of the child is essential to formulating a proper decision. In the present literature review, we have discussed the importance of radiological skeletal assessment in the early detection of child abuse. Conducting radiological skeletal surveys can play a significant role in detecting findings that can indicate the presence of physical abuse. X-ray, bone scan, and bedtime ultrasonography can be used to achieve this with variable sensitivities. However, X-ray remains the most sensitive, and the other two modalities should be used when performing X-ray is not appropriate. Two modalities can also be used at a time for better performance and enhanced outcomes. Imaging should be undertaken by at least one experienced radiologist for better interpretation of the findings. Finally, radiological skeletal surveys may be optimal for children of approximately two years of age, while in other children ≥ five years old, a case-bycase determination of assessment should be carried out.

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Improving national standards of child protection skeletal surveys: the value of College guidance

Abstract: There has been an improvement in the content of skeletal surveys performed in England, which in part may be due to the publication of the national joint Royal College guidance; however, there remain areas for continued development in order to improve practice further.

Cited by 13 publications

References 4 publications

Imaging of non‐accidental injury; what is clinical best practice?

Imaging of non‐accidental injury; what is clinical best practice?

Chest radiographs versus CT for the detection of rib fractures in children (DRIFT): a diagnostic accuracy observational study

Importance of Radiological Skeletal Assessment for Early Detection of Child Abuse

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