Article

Use of the skeletal survey in the evaluation of child maltreatment.

Department of Emergency Medicine, Cooper Hospital/University Medical Center, UMDNJ-Robert Wood Johnson Medical School at Camden, Camden, NJ, USA.
American Journal of Emergency Medicine (impact factor: 1.98). 04/2001; 19(2):122-4. DOI:10.1053/ajem.2001.21345
Source: PubMed

ABSTRACT The radiologic skeletal survey is an important tool for evaluating occult trauma in suspected child abuse. The purposes of this study were: (1) to determine the incidence of clinically unsuspected fractures detected by skeletal survey, and (2) to identify high-risk groups of children who would benefit from skeletal surveys. We retrospectively reviewed the medical records of 203 children admitted over a 30-month period to Children's National Medical Center for alleged physical abuse. Skeletal surveys were ordered based on the treating physicians' clinical suspicions. Patients in whom skeletal surveys were positive for an occult fracture were studied in more detail. There were 96 skeletal surveys performed; of these, 25 were positive for at least 1 clinically unsuspected fracture. Eighty percent of occult fractures were found in children younger than 1 year old. Presenting with a new fracture or an intracranial injury placed the child at higher risk of occult fracture. In contrast, patients with burn injuries had a very low yield of occult fractures. The patient's age and type of suspicious injury can help guide the physician as to when to obtain a skeletal survey.

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    Article: Patterns of skeletal fractures in child abuse: systematic review.
    Alison M Kemp, Frank Dunstan, Sara Harrison, Susan Morris, Mala Mann, Kim Rolfe, Shalini Datta, D Phillip Thomas, Jonathan R Sibert, Sabine Maguire
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    ABSTRACT: To systematically review published studies to identify the characteristics that distinguish fractures in children resulting from abuse and those not resulting from abuse, and to calculate a probability of abuse for individual fracture types. Systematic review. All language literature search of Medline, Medline in Process, Embase, Assia, Caredata, Child Data, CINAHL, ISI Proceedings, Sciences Citation, Social Science Citation Index, SIGLE, Scopus, TRIP, and Social Care Online for original study articles, references, textbooks, and conference abstracts until May 2007. Comparative studies of fracture at different bony sites, sustained in physical abuse and from other causes in children <18 years old were included. Review articles, expert opinion, postmortem studies, and studies in adults were excluded. Data extraction and synthesis Each study had two independent reviews (three if disputed) by specialist reviewers including paediatricians, paediatric radiologists, orthopaedic surgeons, and named nurses in child protection. Each study was critically appraised by using data extraction sheets, critical appraisal forms, and evidence sheets based on NHS Centre for Reviews and Dissemination guidance. Meta-analysis was done where possible. A random effects model was fitted to account for the heterogeneity between studies. In total, 32 studies were included. Fractures resulting from abuse were recorded throughout the skeletal system, most commonly in infants (<1 year) and toddlers (between 1 and 3 years old). Multiple fractures were more common in cases of abuse. Once major trauma was excluded, rib fractures had the highest probability for abuse (0.71, 95% confidence interval 0.42 to 0.91). The probability of abuse given a humeral fracture lay between 0.48 (0.06 to 0.94) and 0.54 (0.20 to 0.88), depending on the definition of abuse used. Analysis of fracture type showed that supracondylar humeral fractures were less likely to be inflicted. For femoral fractures, the probability was between 0.28 (0.15 to 0.44) and 0.43 (0.32 to 0.54), depending on the definition of abuse used, and the developmental stage of the child was an important discriminator. The probability for skull fractures was 0.30 (0.19 to 0.46); the most common fractures in abuse and non-abuse were linear fractures. Insufficient comparative studies were available to allow calculation of a probability of abuse for other fracture types. When infants and toddlers present with a fracture in the absence of a confirmed cause, physical abuse should be considered as a potential cause. No fracture, on its own, can distinguish an abusive from a non-abusive cause. During the assessment of individual fractures, the site, fracture type, and developmental stage of the child can help to determine the likelihood of abuse. The number of high quality comparative research studies in this field is limited, and further prospective epidemiology is indicated.
    BMJ (Clinical research ed.). 01/2008; 337:a1518.
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    Article: Which injuries may indicate child abuse?
    S Maguire
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    ABSTRACT: Making the decision as to whether an injury is a result of child abuse or not is stressful for both the family involved and the clinical team. It is not a decision that is taken lightly, and with an increasing expectation by the investigating agencies, lawyers and the public in general, to ensure that it is based on explicit 'evidence', clinicians need to be up to date with the latest scientific publications in the field. This article aims to summarise the current evidence in relation to all physical injuries except those pertaining to the central nervous system, which will form a separate article. It will examine the pattern of accidental and abusive bruises, fractures, burns, abdominal injuries and oral injuries focusing on discriminating features and necessary investigations.
    Archives of Disease in Childhood - Education and Practice 10/2010; 95(6):170-7. · 1.32 Impact Factor
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    Article: Pattern of injury in child fatalities resulting from child abuse.
    Ann H Ross, Suzanne M Abel, Deborah Radisch
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    ABSTRACT: According to the US Department of Health and Human Services, in 2005, an estimated 1460 children died of maltreatment. The purpose of this study is to further examine the pattern of bony injuries in child maltreatment fatalities, with an emphasis on the prevalence of antemortem fractures and the presence of associated perimortem fractures. The sample was 162 male and female children. The majority of the data were collected from the case files of the NC Child Fatality Prevention Team at the Office of the Chief Medical Examiner in Chapel Hill, North Carolina (n=152) spanning from 2000 to 2005. An additional 10 cases from 2001 to 2006 were included from the Charleston County Coroner's Office, Charleston, SC. Six age categories were used in this study: 0-3 months, 4-6 months, 7-9 months, 10-16 months, 17 months to 2 years, and 2-6 years. Lesions were documented and categorized into four general body loci: craniofacial, thoraco/abdominal, appendicular, and multiple. The peak age categories of death were 0-3 months (25%) and 2-6 years (19%), with 50% of deaths occurring in infants 9 months old or younger. The body locus most frequently affected was craniofacial.
    Forensic science international 05/2009; 188(1-3):99-102. · 2.10 Impact Factor

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Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

1 clinically unsuspected fracture
 
1 year old
 
30-month period
 
child abuse
 
children
 
children younger
 
Children's National Medical Center
 
clinically unsuspected fractures
 
high-risk groups
 
higher risk
 
intracranial injury
 
low yield
 
new fracture
 
occult fracture
 
occult fractures
 
occult trauma
 
radiologic skeletal survey
 
skeletal survey
 
skeletal surveys
 
treating physicians' clinical suspicions
 

R A Belfer