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Published on: January 29, 2018
Yield of skeletal survey by age in children referred to abuse specialists
Daniel M Lindberg1, Rachel P Berger2, Maegan S Reynolds3
1Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Department of Pediatrics, Kempe Center for the Prevention and Treatment of Child Abuse, Children's Hospital of Colorado, Aurora, CO.
Insights
Skeletal surveys are crucial for identifying fractures in abused children under 36 months. Rates of completion decrease significantly after 36 months, highlighting the need for timely evaluations.
Area of Science:
- Pediatric medicine
- Forensic medicine
- Radiology
Background:
- Physical abuse is a significant concern in children requiring medical evaluation.
- Skeletal surveys are a key diagnostic tool for identifying fractures in suspected physical abuse cases.
Purpose of the Study:
- To analyze the relationship between age and the completion rates of skeletal surveys.
- To determine the efficacy of skeletal surveys in identifying fractures across different pediatric age groups.
Main Methods:
- Retrospective analysis of an observational study involving 2609 children under 60 months evaluated for physical abuse.
- Categorization of children into 6-month age cohorts to assess skeletal survey completion and fracture identification rates.
Main Results:
- Skeletal surveys were completed in 78% of subjects, identifying new fractures in 18%.
- Completion rates exceeded 50% for children up to 36 months but dropped below 35% for older children.
- Fracture identification rates were comparable between 12-24 month olds (12.0%) and 24-36 month olds (10.3%).
Conclusions:
- Skeletal surveys are effective in detecting new fractures in children evaluated for abuse.
- Current guidelines recommending skeletal surveys for all children under 24 months are supported.
- A low threshold for obtaining skeletal surveys is recommended for children up to 36 months.
Objective:
To determine rates of skeletal survey completion and injury identification as a function of age among children who underwent subspecialty evaluation for concerns of physical abuse.
Study Design:
This was a retrospective secondary analysis of an observational study of 2609 children <60 months of age who underwent evaluation for possible physical abuse. We measured rates of skeletal survey completion and fracture identification for children separated by age into 6-month cohorts.
Results:
Among 2609 subjects, 2036 (78%) had skeletal survey and 458 (18%) had at least one new fracture identified. For all age groups up to 36 months, skeletal survey was obtained in >50% of subjects, but rates decreased to less than 35% for subjects >36 months. New fracture identification rates for skeletal survey were similar between children 24-36 months of age (10.3%, 95% CI 7.2-14.2) and children 12-24 months of age (12.0%, 95% CI 9.2-15.3) CONCLUSIONS: Skeletal surveys identify new fractures in an important fraction of children referred for subspecialty consultation with concerns of physical abuse. These data support guidelines that consider skeletal survey mandatory for all such children <24 months of age and support a low threshold to obtain skeletal survey in children as old as 36 months.
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