G14a

ASSESSING THE USE OF SKELETAL SURVEYS TO EVALUATE FOR TRAUMA: CAN WE PREDICT WHICH CHILDREN ARE MOST LIKELY TO HAVE CLINICALLY UNSUSPECTED FRACTURES?
 

Presenter: Shanna O. Duffy

Abstract Category: 

Instruction Level: 

Presentation: Not Provided

Description:   

Analyzing the use of skeletal surveys as a screening tool for physical abuse

Abstract:

BACKGROUND. The skeletal survey (SS) is the most commonly-used tool for detection of clinically unsuspected fractures in young children in whom there is a concern for physical abuse.

OBJECTIVES. (1) To describe the use of SS in a large pediatric tertiary care center (2) To identify characteristics of children who are most likely to have clinically unsuspected fractures identified by SS. 

DESIGN/METHODS. Records of all children who had a SS performed over a 4-year period were retrospectively reviewed. Demographic information, reason for performing the SS, and results of the SS were recorded. A ‘positive SS’ was defined as one which revealed fracture(s) for which there was no clinical suspicion.

RESULTS. 706 children had a SS between 4/1/02 and 4/1/06. The most common reasons for performing SS were (1) presence of recognized fracture (2) other features of child abuse (e.g. bruising, brain injury), and (3) social concerns. 14.3% (101/706) of SS were positive; the number of SS performed and the proportion of positive SS was stable over the 4-year study period. Patients with a positive SS were younger than those with a negative SS [median (range); 4 (0-76) vs. 8 (0-144) months, p=.05]. The proportion of positive SS was not related to the reason for performing the SS except in the subgroup of children with brain injury in who the proportion of positive SS was significantly higher (24.7% vs. 14.3%, p=0.02). Every bone included in the SS was fractured in at least one child. Clinically unsuspected fractures were most often found in the lower extremities.

CONCLUSIONS. This is the largest study to date to describe the use of SS in children with suspected physical abuse. The findings that younger children and those with brain injury are at highest risk for a positive SS is consistent with previous literature.  The rate of positive SS of 14.3% is lower than in most previous studies and likely is the result of including all children who underwent SS and not only those who were admitted to the hospital or those in whom there was a diagnosis of suspected abuse. Future analysis will focus on the role of the repeat SS.