TY - JOUR
T1 - Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital
AU - Loos, Marie Louise H.J.
AU - Ahmed, Tayiba
AU - Bakx, Roel
AU - van Rijn, Rick R.
N1 - Publisher Copyright:
© 2020, The Author(s).
PY - 2020/9/1
Y1 - 2020/9/1
N2 - 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.
AB - 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.
KW - Fractures and dislocations
KW - Non accidental injury
KW - Paediatric injury
KW - Skeletal survey
KW - x-ray
UR - http://www.scopus.com/inward/record.url?scp=85087019651&partnerID=8YFLogxK
U2 - 10.1007/s00383-020-04706-z
DO - 10.1007/s00383-020-04706-z
M3 - Article
C2 - 32591847
AN - SCOPUS:85087019651
SN - 0179-0358
VL - 36
SP - 1009
EP - 1017
JO - Pediatric Surgery International
JF - Pediatric Surgery International
IS - 9
ER -