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Value of radiologic skeletal survey in assessment of abused children
Insights
Radiologic skeletal surveys are rarely helpful in diagnosing child abuse, providing new information in only 8 of 331 cases. This study questions the routine use of skeletal surveys for suspected child maltreatment.
Area of Science:
- Pediatric Radiology
- Child Abuse and Neglect Research
Background:
- Child maltreatment evaluations often involve radiologic skeletal surveys.
- The diagnostic yield of these surveys in suspected abuse cases requires further examination.
Purpose of the Study:
- To assess the utility of radiologic skeletal surveys in evaluating children with suspected abuse or neglect.
- To determine the rate at which skeletal surveys provide new, crucial information in child maltreatment investigations.
Main Methods:
- A retrospective review of 331 skeletal surveys conducted over 2.5 years at a pediatric hospital.
- Analysis of survey results, correlating findings with known or suspected trauma and clinical factors.
Main Results:
- Only 11.5% (38/331) of skeletal surveys revealed evidence of trauma.
- In most positive cases (30/38), the trauma was already known or suspected.
- Skeletal surveys provided new, actionable information in only 8 cases (2.4%).
Conclusions:
- The routine use of radiologic skeletal surveys in evaluating suspected child abuse and neglect may have limited diagnostic value.
- The cost-benefit analysis, considering risks and limited new information, suggests a need to re-evaluate current practices.
Abstract:
The usefulness of the radiologic skeletal survey in the assessment of children who were suspected of being abused or neglected was studied. During a 2 1/2-year period at one pediatric hospital, 331 skeletal surveys were performed to aid in the evaluation of possible child maltreatment. Of the 331 surveys, 38 (11.5%) showed evidence of trauma. But, in 30 of the 38 skeletal surveys, trauma was either previously known or suspected by the examiner. Therefore, in only eight cases did the skeletal survey provide new information that was helpful in the investigation of possible abuse or neglect which would have remained undiscovered without the skeletal survey. The age, sex, and clinical signs of the subjects were analyzed in an attempt to identify factors that might predict skeletal surveys with positive radiologic findings. Consideration is given to the costs and risks of skeletal surveys v potential benefits.