Follow-up skeletal surveys for suspected non-accidental trauma: Can a more limited survey be performed without compromising diagnostic information?

Objective: Follow-up skeletal surveys have been shown to improve the rate of fracture detection in suspected cases of non-accidental trauma (NAT) As these studies ale performed in a particularly radiosensitive population, it is important to evaluate if all of the (approximately 20) radiographs obtained at repeat skeletal survey are clinically useful Our goal was to evaluate if certain radiographs can be excluded at follow-up skeletal survey without compromising the clinical efficacy Methods: This retrospective study included 22 cases of suspected NAT (average age 38 months, range 07-15 months) in which patients received both initial and follow-up bone surveys The follow-up survey was performed an aver age of 167 clays (range 11-29 clays) after the initial survey Radiographs were reviewed by 2 pediatric radiologists, with discrepancies resolved by consensus In addition, we combined our data with data from all known previously published reports of follow-up skeletal surveys for NAT for meta-analysts Results: A total of 36 fractures were found on the initial bone survey in 16/22 patients (73%) Six patients had no fractures detected at initial survey Follow-up bone surveys demonstrated an additional 3 fractures (2 extremities and 1 rib) in 3/22 cases (14%), 1 was in a patient whose initial survey was negative No additional fractures in the skull, spine, pelvis, feet, or hands were detected in any case In combination with patients reported in the literature (194 patients total) no new fracture of the skull, spine, pelvis, or hands was detected at follow-up survey The skull, spine and pelvis radiographs are the highest dose-exposure studies of the skeletal survey Conclusion and practice implications: If no injury is detected or suspected in the pelvis, spine, hands, or skull at initial bone survey for suspected NAT, a limited follow-up skeletal survey which excludes the pelvis, lateral spine, hands, and skull should be considered to limit radiation exposure without limiting diagnostic information (C) 2010 Elsevier Ltd All rights reserved