Related Experiment Video
Updated: May 14, 2026
Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
The utility of follow-up skeletal surveys in child abuse
Nancy S Harper1, Sonja Eddleman, Daniel M Lindberg
1Driscoll Children's Hospital, Corpus Christi, TX 78411, USA. nancy.harper@dchstx.org
Insights
Follow-up skeletal surveys (FUSS) identified new information in nearly a quarter of children evaluated for physical abuse. These imaging studies can alter the perceived likelihood of abuse, supporting their use in clinical evaluations.
Area of Science:
- Pediatric Radiology
- Child Abuse Pediatrics
- Forensic Radiology
Background:
- Follow-up skeletal surveys (FUSS) are frequently used in evaluating suspected child physical abuse.
- Existing evidence supporting FUSS is primarily from small, retrospective studies.
Purpose of the Study:
- To determine the proportion of FUSS that yield new diagnostic information in a large, multicenter cohort of children with concerns for physical abuse.
- To assess the impact of FUSS findings on the perceived likelihood of abuse.
Main Methods:
- Prospective secondary analysis of an observational study involving children under 10 years old evaluated by 20 US child abuse teams.
- Included children recommended for FUSS, measuring completion rates, findings, and changes in abuse likelihood before and after the survey.
Main Results:
- Of 796 children who underwent FUSS, 174 (21.5%) had new information identified.
- New fractures were found in 15.6% of cases, and reassuring findings in 6.9%.
- In cases with new fractures, the likelihood of abuse increased in 33% and remained maximal in 41%.
Conclusions:
- Follow-up skeletal surveys identify new information and influence the perceived likelihood of abuse in a significant proportion of evaluated children.
- These findings support current guidelines and suggest considering FUSS even in cases with lower initial suspicion of abuse.
Objective:
Follow-up skeletal surveys (FUSS) are performed frequently in cases of possible physical abuse based on the evidence from small retrospective cohorts. Our objective was to determine the proportion of FUSS that identified new information in a large, multicenter population of children with concerns of physical abuse.
Methods:
This was a prospective secondary analysis of an observational study of all children <10 years of age (120 months) who underwent evaluation for possible physical abuse by 20 US child abuse teams. This analysis included all children in whom FUSS was recommended and measured rates of FUSS completion, results of FUSS, and the change in perceived likelihood of abuse before and after FUSS.
Results:
Among 2890 children enrolled in the Examining Siblings To Recognize Abuse research network, 2049 underwent skeletal survey and 796 (38.8%) had FUSS. A total of 174 (21.5%) subjects had new information identified by FUSS, including 124 (15.6%) with at least 1 new fracture and 55 (6.9%) with reassuring findings compared with the initial skeletal survey. Among cases with new fractures, the estimated likelihood of abuse increased in 41 (33%) cases, and 51 cases (41%) remained at the maximum likelihood of abuse.
Conclusions:
FUSS identified new information and affected the perceived likelihood of abuse in a substantial fraction of cases in which it was completed. These data support existing guidelines and, in addition, suggest that FUSS should be considered in cases with lower initial levels of concern for abuse.
