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2011 ; 127
(1
): e47-52
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Use of skeletal surveys to evaluate for physical abuse: analysis of 703
consecutive skeletal surveys
#MMPMID21149429
Duffy SO
; Squires J
; Fromkin JB
; Berger RP
Pediatrics
2011[Jan]; 127
(1
): e47-52
PMID21149429
show ga
OBJECTIVES: The goals were to assess the use of the skeletal survey (SS) to
evaluate for physical abuse in a large consecutive sample, to identify
characteristics of children most likely to have unsuspected fractures, and to
determine how often SS results influenced directly the decision to make a
diagnosis of abuse. METHODS: A retrospective, descriptive study of a consecutive
sample of children who underwent an SS at a single children's hospital over 4
years was performed. Data on demographic characteristics, clinical presentation,
SS results, and effects of SS results on clinical diagnoses were collected. A
positive SS result was defined as a SS which identified a previously unsuspected
fracture(s). RESULTS: Of the 703 SSs, 10.8% yielded positive results. Children <6
months of age, children with an apparent life-threatening event or seizure, and
children with suspected abusive head trauma had the highest rates of positive SS
results. Of children with positive SS results, 79% had ?1 healing fracture.
CONCLUSIONS: This is the largest study to date to describe the use of the SS.
Almost 11% of SS results were positive. The SS results influenced directly the
decision to make a diagnosis of abuse for 50% of children with positive SS
results. These data, combined with the high morbidity rates for missed abuse and
the large proportion of children with healing fractures detected through SS,
suggest that broader use of SS, particularly for high-risk populations, may be
warranted.