Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep;36(9):1009-1017.
doi: 10.1007/s00383-020-04706-z. Epub 2020 Jun 26.

Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital

Marie-Louise H J Loos  1 , Tayiba Ahmed  2 , Roel Bakx  3 , Rick R van Rijn  2   4
Affiliations

Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital

Marie-Louise H J Loos et al. Pediatr Surg Int. 2020 Sep.

Abstract

Purpose: The purpose of the study was to determine the rate of occult fractures (without clinical symptoms) per presenting clinical injury i.e., children presenting with a fracture, bruise, abusive head trauma and the types of fracture most likely to be found, in a series of infants and young children suspected of being victims of NAT.

Methods: Skeletal surveys done between 2008 and 2018 of children (< 5 years) were retrospectively analyzed. Both radiographs of admitted children and reassessment images from all over the country were included and reviewed by a forensic paediatric radiologist. Deceased children were excluded. Variables as gender, age, initial clinical injury and occult fractures were collected. Occult fractures on the follow-up skeletal survey were collected.

Results: A total of 370 skeletal surveys of 296 children were included. Median age was 22 weeks (IQR 11-48), there were 172 (58%) boys. A total of 195 occult fractures were detected in 111 (32%) children. Occult fractures were detected in 37/126 (29%) children with fracture as presenting symptom, 33/90 (37%) children with head trauma and 26/50 (52%) children with bruises. Rib (n = 56, 50%) and lower leg (n = 40, 36%) fractures were most detected.

Conclusion: Occult fractures were detected in 32% of the children. Occult fractures were most prevalent if the initial clinical injury suggestive for NAT to request skeletal survey was a bruise, abusive head trauma or fracture.

Keywords: Fractures and dislocations; Non accidental injury; Paediatric injury; Skeletal survey; x-ray.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest relevant to this article to disclose.

Figures

Fig. 1
Fig. 1
Prevalence and distribution of fractures (index fractures excluded). Total number of fracture location in children detected on the positive skeletal survey (primary and follow-up merged) and proportion (%) of the located fracture in all positive skeletal surveys (n = 111); e.g., in 56 children a rib fracture was detected, which is 50% of all children with a positive skeletal survey
Fig. 2
Fig. 2
Prevalence and distribution of detected rib fractures on skeletal surveys (total rib fractures n = 216)
See this image and copyright information in PMC

References

    1. The royal college of radiologists; the society and college of radiographers, the radiological investigation of suspected physical abuse in children, 2018. www.rcr.ac.uk. Accessed 16 April 2020
    1. The royal college of radiologists; the royal college of paediatrics and child health, standards for radiological investigations of suspected non-accidental injury, 2008. www.rcr.ac.uk. Accessed 16 April 2020
    1. Kleinman PK, Marks SC, Adams VI, Blackbourne BD. Factors affecting visualization of posterior rib fractures in abused infants. AJR Am J Roentgenol. 1988;150:635–638. doi: 10.2214/ajr.150.3.635. - DOI - PubMed
    1. Barber I, Perez-Rossello JM, Wilson CR, Kleinman PK. The yield of high-detail radiographic skeletal surveys in suspected infant abuse. Pediatr Radiol. 2015;45:69–80. doi: 10.1007/s00247-014-3064-3. - DOI - PubMed
    1. Wootton-Gorges SL, Soares BP, Alazraki AL, Anupindi SA, Blount JP, et al. Expert panel on pediatric I ACR appropriateness criteria ((R)) suspected physical abuse-child. J Am Coll Radiol. 2017;14(S338):S49. - PubMed