Follow-up skeletal surveys for nonaccidental trauma: can a more limited survey be performed?

Pediatr Radiol. 2009 Sep;39(9):962-8. doi: 10.1007/s00247-009-1313-7. Epub 2009 Jun 30.


Background: Studies have demonstrated the value of the follow-up skeletal survey in identifying additional fractures, clarifying indeterminate findings, and improving dating of skeletal injuries in victims of physical abuse.

Objective: To determine whether a more limited follow-up survey could yield the same radiologic data as a full follow-up survey.

Materials and methods: The study cohort comprised 101 children who had follow-up surveys that met our inclusion criteria. Consensus readings of both original and follow-up surveys were performed by two pediatric radiologists. These results were compared to determine additional findings from the follow-up surveys. Limited skeletal survey protocols were evaluated to determine whether they would detect the same fractures seen with a complete osseous survey.

Results: In the 101 children 244 fractures were identified on the initial osseous survey. Follow-up surveys demonstrated new information in 38 children (37.6%). A 15-view limited follow-up survey identified all additional information seen on the complete follow-up survey.

Conclusion: Our data demonstrate that a 15-view limited follow-up skeletal survey could be performed without missing clinically significant new fractures and still allow proper identification of confirmed fractures or normal findings. A limited survey would decrease radiation dose in children.

MeSH terms

  • Accidents / statistics & numerical data
  • Child Abuse / diagnosis*
  • Child Abuse / statistics & numerical data*
  • Child, Preschool
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Fractures, Bone / diagnostic imaging*
  • Fractures, Bone / epidemiology*
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Radiography
  • Risk Assessment / methods
  • Risk Factors
  • Utah / epidemiology