The role of the follow-up chest radiograph in suspected non-accidental injury

Anilkumar, Adikesavalu; Fender, Laura; Broderick, N.; Somers, John; Halliday, K.

doi:10.1007/s00247-005-0054-5

Cited by 23 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A separate study evaluating the role of the follow-up chest radiograph in suspected NAI showed similar issues with a 70% non-attendance rate. 37 This was not acceptable with regards to the safety of the child, and on balance, the paediatricians felt that the risk to the child outweighed the higher radiation dose incurred by BS. As a result, and also coinciding with the publication of the national guidelines, 7 practice reverted to initial BS and SS for all cases of suspected NAI.…”

Section: Study Limitationsmentioning

confidence: 99%

Should bone scintigraphy be used as a routine adjunct to skeletal survey in the imaging of non-accidental injury? A 10 year review of reports in a single centre

Bainbridge¹,

Huey²,

Harrison³

2015

Clinical Radiology

View full text Add to dashboard Cite

Section: Study Limitationsmentioning

confidence: 99%

Should bone scintigraphy be used as a routine adjunct to skeletal survey in the imaging of non-accidental injury? A 10 year review of reports in a single centre

Bainbridge¹,

Huey²,

Harrison³

2015

Clinical Radiology

View full text Add to dashboard Cite

“…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: 86%

“…The standard radiography survey of the infant skeleton must include follow-up radiographs, 1 because acute rib fractures can be difficult to detect and callus formation within 11–14 days of injury makes healing rib fractures detectable on chest radiographs. Follow-up radiographs detect new fractures in approximately 8–28% of cases that return 23, 24. 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.…”

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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...

show abstract

“…It is uncommon to detect these fractures in the acute phase as they are better seen when callus formation is advanced. A followup chest Xray may, therefore, provide useful information in children with suspected nonaccidental injury and may improve detection [3,4].…”

Section: Discussionmentioning

confidence: 99%

Rib fractures: Accidental or non-accidental

Waseem¹,

Erickson²

2013

IJCRI

View full text Add to dashboard Cite

Introduction: We report an incidental discovery of multiple rib fractures in a wheezing child without a history of an injury or the presence of metabolic bone disease. As a result, the child was evaluated for the presence of non accidental trauma. Case Report: An 11month old AfricanAmerican child was brought to the emergency department by his father with a 2 day history of fever, cough and breathing difficulty. After receiving nebulizer treatments, the child was still wheezing. A chest Xray was obtained which showed bilateral fractures of the ribs. No history of trauma was provided. Given the radiographic findings, Child Protective Services was contacted and a report of child abuse was made. Conclusion: Child abuse is a complex phenomenon. Any skeletal injury in young children can be due to abuse. Rib fractures are uncommon in the pliable chest of a child. When discovered, however, they raise the suspicion of a nonaccidental trauma. They are often uncovered during the assessment of children who present to the emergency department for unrelated reasons. The physician's ability to differentiate accidental from nonaccidental trauma may depend on gathered information. This report emphasized the importance to evaluate for nonaccidental trauma after the finding of bilateral rib fractures on a chest Xray. Nonaccidental trauma should be considered when there is evidence of injury without a history of trauma.

show abstract

The role of the follow-up chest radiograph in suspected non-accidental injury

Abstract: The follow-up chest radiograph provides useful information in children with suspected NAI and it is recommended that it should be included routinely in the imaging investigations of these children.

Cited by 23 publications

References 7 publications

Should bone scintigraphy be used as a routine adjunct to skeletal survey in the imaging of non-accidental injury? A 10 year review of reports in a single centre

Should bone scintigraphy be used as a routine adjunct to skeletal survey in the imaging of non-accidental injury? A 10 year review of reports in a single centre

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

Rib fractures: Accidental or non-accidental

Contact Info

Product

Resources

About