Clinical Radiology
Volume 61, Issue 9 , Pages 723-736 , September 2006

Which radiological investigations should be performed to identify fractures in suspected child abuse?

  • A.M. Kemp

      Affiliations

    • Welsh Child Protection Systematic Review Group1, Departments of Child Health
    • Corresponding Author InformationGuarantor and correspondent: A. Kemp, Department of Child Health, Cardiff University, Academic Centre, Llandough Hospital, Penarth, CF64 2XX, Wales, UK. Tel.: +44 2920 716933; fax: +44 2920 350140.
  • ,
  • A. Butler

      Affiliations

    • Radiology
  • ,
  • S. Morris

      Affiliations

    • Radiology
  • ,
  • M. Mann

      Affiliations

    • Support Unit for Research Evidence, Cardiff University, UK
  • ,
  • K.W. Kemp

      Affiliations

    • Welsh Child Protection Systematic Review Group1, Departments of Child Health
  • ,
  • K. Rolfe

      Affiliations

    • Welsh Child Protection Systematic Review Group1, Departments of Child Health
  • ,
  • J.R. Sibert

      Affiliations

    • Welsh Child Protection Systematic Review Group1, Departments of Child Health
  • ,
  • S. Maguire

      Affiliations

    • Welsh Child Protection Systematic Review Group1, Departments of Child Health

Received 1 July 2005 ,Revised 22 March 2006 ,Accepted 28 March 2006.

References 

  1. Loder RT, Bookout C. Fracture patterns in battered children. J Orthop Trauma. 1991;5:428–433
  2. Kogutt MS, Swischuk LE, Fagan CJ. Patterns of injury and significance of uncommon fractures in the battered child syndrome. AJR Am J Roentgenol. 1974;121:143–149
  3. Worlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study. BMJ. 1986;293:100–102
  4. Barsness KA, Cha ES, Bensard DD, et al. The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. J Trauma-Injury Infect Crit Care. 2003;54:1107–1110
  5. Merten DF, Radlowski MA, Leonidas JC. The abused child: A radiological reappraisal. Radiology. 1983;146:377–381
  6. Cadzow SP, Armstrong KL. Rib fractures in infants: red alert! The clinical features, investigations and child protection outcomes. J Paediatr Child Health. 2000;36:322–326
  7. Jeerathanyasakun Y, Hiranyavanitch P, Bhummichitra D, et al. Causes of femoral shaft fracture in children under five years of age. J Med Assoc Thai. 2003;86:S661–S666
  8. Leventhal JM, Thomas SA, Rosenfield NS, et al. Fractures in young children. Distinguishing child abuse from unintentional injuries. Am J Dis Children. 1993;147:87–92
  9. Kleinman PK, Marks SC, Adams VI, et al. Factors affecting visualization of posterior rib fractures in abused infants. AJR Am J Roentgenol. 1988;150:635–638
  10. Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural haematoma. AJR Am J Roentgenol. 1946;56:163–173
  11. BSPR NAI standard for skeletal surveys http://www.bspr.org.uk/. Accessed March 2006.
  12. ACR revised standards for SS in children. http://www.acr.org/s_acr/bin.asp?TrackID=&SID=1&DID=12286&CID=543&VID=2&DOC=File.PDF. Accessed March 2006.
  13. Smith FW, Gilday DL, Ash JM, et al. Unsuspected costo-vertebral fractures demonstrated by bone scanning in the child abuse syndrome. Pediatr Radiol. 1980;10:103–106
  14. Frye TR, Shores RM, Slovis TL, et al. Radiological case of the month. Child abuse. Am J Dis Child. 1984;138:323–324
  15. Haase GM, Ortiz VN, Sfakianakis GN, et al. The value of radionuclide bone scanning in the early recognition of deliberate child abuse. J Trauma. 1980;20:873–875
  16. Kleinman PK, Blackbourne BD, Marks SC, et al. Radiologic contributions to the investigation and prosecution of cases of fatal infant abuse. N Engl J Med. 1989;320:507–511
  17. NHS Centre for Reviews and Dissemination . Undertaking Systematic Reviews of Research on Effectiveness. CRD's Guidance for those Carrying Out or Commissioning Reviews CRD Report No. 4. 2nd ed.. University of York; 2001;
  18. Nimkin K, Spevak MR, Kleinman PK. Fractures of the hands and feet in child abuse: imaging and pathological features. Radiology. 1997;203:233–236
  19. Sty JR, Starshak RJ. The role of bone scintigraphy in the evaluation of the suspected abused child. Radiology. 1983;146:369–375
  20. Pickett WJ, Faleski EJ, Chacko A, et al. Comparison of radiographic and radionuclide skeletal surveys in battered children. South Med J. 1983;76:207–212
  21. Kleinhans E, Kentrup H, Alzen G, et al. Falsch-negatives skelett-szintigramm bei einer biparietalen schadelfraktur beim “Battered Child”-Syndrom (Falsely negative bone scintigram in a case of a Battered-Child Syndrome with biparietal skull fractures). Nucl Med (Stuttg). 1993;32:206–207
  22. Jaudes PK. Comparison of radiography and radionuclide bone scanning in the detection of child abuse. Pediatrics. 1984;73:166–168
  23. Olesen T, Egeblad M, Dige-Petersen H, et al. Somatic manifestations in children suspected of having been maltreated. Acta Paediatr Scand. 1988;77:154–160
  24. Mandelstam SA, Cook D, Fitzgerald M, et al. Complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse. Arch Dis Child. 2003;88:387–390
  25. Ablin DS, Greenspan A, Reinhart MA. Pelvic injuries in child abuse. Pediatr Radiol. 1992;22:454–457
  26. Merten DF, Kirks DR, Ruderman RJ. Occult humeral epiphyseal fracture in battered infants. Pediatr Radiol. 1981;10:151–154
  27. Conway JJ, Collins M, Tanz RR, et al. The role of bone scintigraphy in detecting child abuse. Semin Nucl Med. 1993;23:321–333
  28. Kleinman PK, Nimkin K, Spevak MR, et al. Follow-up skeletal surveys in suspected child abuse. AJR Am J Roentgenol. 1996;167:893–896
  29. Zimmerman S, Makoroff K, Care M, et al. Utility of follow-up skeletal surveys in suspected child physical abuse evaluations. Child Abuse Negl. 2005;29:1075–1083
  30. Ingram JD, Connell J, Hay TC, et al. Oblique radiographs of the chest in nonaccidental trauma. Emerg Radiol. 2000;7:42–46
  31. Anderson WA. The significance of femoral fractures in children. Ann Emerg Med. 1982;11:174–177
  32. Beals RK, Tufts E. Fractured femur in infancy: the role of child abuse. J Pediatr Orthop. 1983;3:583–586
  33. Kleinman PK, Marks SC. A regional approach to the classic metaphyseal lesion in abused infants: the proximal humerus. AJR Am J Roentgenol. 1996;167:1399–1403
  34. Jaffe AC, Lasser DH. Multiple metatarsal fractures in child abuse. Pediatrics. 1977;60:642–643
  35. Gabos PG, Tuten HR, Leet A, et al. Fracture–dislocation of the lumbar spine in an abused child. Pediatrics. 1998;101:473–477
  36. Diamond P, Hansen CM, Christofersen MR. Child abuse presenting as a thoracolumbar spinal fracture dislocation: a case report. Pediatr Emerg Care. 1994;10:83–86
  37. Carrion WV, Dormans JP, Drummond DS, et al. Circumferential growth plate fracture of the thoracolumbar spine from child abuse. J Pediatr Orthop. 1996;16:210–214
  38. Rooks VJ, Sisler C, Burton B. Cervical spine injury in child abuse: report of two cases. Pediatr Radiol. 1998;28:193–195
  39. Ellerstein NS, Norris KJ. Value of radiologic skeletal survey in assessment of abused children. Pediatrics. 1984;74:1075–1078
  40. Belfer RA, Klein BL, Orr L. Use of the skeletal survey in the evaluation of child maltreatment. Am J Emerg Med. 2001;19:122–124
  41. Johnson K, Chapman S, Hall CM. Skeletal injuries associated with sexual abuse. Pediatr Radiol. 2004;34:620–623
  42. Mariacher-Gehler S, Michel BA. Sonography: a simple way to visualize rib fractures. AJR Am J Roentgenol. 1994;163:1268
  43. Beltran J, Rosenberg ZS, Kawelblum M, et al. Pediatric elbow fractures: MRI evaluation. Skeletal Radiol. 1994;23:277–281
  44. Dias JJ, Lamont AC, Jones JM. Ultrasonic diagnosis of neonatal separation of the distal humeral epiphysis. J Bone Joint Surg [Br]. 1988;70-B:825–828
  45. Nimkin K, Kleinman PK, Teeger S, et al. Distal humeral physeal injuries in child abuse: MR imaging and ultrasonography findings. Pediatr Radiol. 1995;25:562–565
  46. Markowitz RI, Hubbard AM, Harty MP, et al. Sonography of the knee in normal and abused infants. Pediatr Radiol. 1993;23:264–267
  47. Smeets AJ, Robben SGF, Meradji M. Sonographically detected costo–chondral dislocation in an abused child: a new sonographic sign to the radiological spectrum of child abuse. Pediatr Radiol. 1990;20:566–567
  48. Kara M, Dikmen E, Erdal HH, et al. Disclosure of unnoticed rib fractures with the use of ultrasonography in minor blunt chest trauma. Eur J Cardio-Thorac Surg. 2003;24:608–613
  49. Tsai FY, Zee CS, Apthorp JS, et al. Computed tomography in child abuse head trauma. J Comput Assist Tomogr. 1980;4:227–286
  50. Cohen RA, Kaufman RA, Myers PA, et al. Cranial computed tomography in the abused child with head injury. AJR Am J Roentgenol. 1986;146:97–102
  51. Saulsbury FT, Alford BA. Intracranial bleeding from child abuse: the value of skull radiographs. Pediatr Radiol. 1982;12:175–178
  52. Markovitz RI, Hubbard AM, Harty MP, et al. Sonography of the knee in normal and abused infants. Pediatr Radiol. 1993;23:264–267
  53. Picano E. Sustainability of medical imaging. BMJ. 2004;328:578–580
  54. Cook JV. Radiation protection and quality assurance in paediatric radiology. Imaging. 2001;13:229–238
  55. Cohen BL. Cancer risk from low-level radiation. AJR Am J Roentgenol. 2002;179:1137–1143
  56. Bury RF. The new ionising radiation regulations — will they make a difference?. Imaging. 2000;12:255–261
  57. Treves ST, Conolly LP, Kirkpatrick JA, et al. Bone. In:  Treves ST editors. Pediatric nuclear medicine. Berlin: Springer; 1995;p. 233–301
  58. Rosenthall L, Hill RO, Chuang S. Observation on the use of 99mTc-phosphate imaging in peripheral bone trauma. Radiology. 1976;119:637–641
  59. Phillips JH, Albregts AE, Kling TF. Digital radiography in pediatric orthopaedics: a prospective controlled and randomised trial. J Pediatr Orthop. 1994;14:377–380
  60. Youmans DC, Don S, Hildebolt C, et al. Skeletal surveys for child abuse: comparison of interpretation using digitized images and screen-film radiographs. AJR Am J Roentgenol. 1998;171:1415–1419
  61. Brown PH, Silberberg PJ, Primack SL, et al. Skeletal surveys using computed radiography (CR) in suspected child abuse: does CR meet the American College of Radiology (ACR) standards? In: International Pediatric Radiology Meeting. Paris, 2001.
  62. Kleinman PK, O'Connor B, Nimkin K, et al. Detection of rib fractures in an abused infant using digital radiography: a laboratory study. Pediatr Radiol. 2002;32:896–901
  63. James SLJ, Halliday K, Somers J, et al. A survey of non-accidental injury imaging in England, Scotland and Wales. Clin Radiol. 2003;58:696–701
  64. Offiah A, Hall C. Observational study of skeletal surveys in suspected non-accidental injury. Clin Radiol. 2003;58:702–705

PII: S0009-9260(06)00140-1

doi: 10.1016/j.crad.2006.03.017

Clinical Radiology
Volume 61, Issue 9 , Pages 723-736 , September 2006