Max Lewis, Presenter: Nothing to Disclose

Boaz Karmazyn MD, Abstract Co-Author: Researcher, Siemens AG

To determine if some of the ACR practice guidelines radiographs for routine skeletal survey can be eliminated to reduce radiation exposure and expense without significant change in sensitivity for detection of fractures.

A database was created of all skeletal surveys performed on children less than two years of age over the course of seven years (January 1, 2003 to December 31, 2009). Repeated follow-up studies were excluded. Reports were analyzed for the presence of fractures and fracture locations were recorded. Skeletal surveys performed for reasons other than suspected child abuse, including postmortem studies, were excluded.

Skeletal surveys were performed on 950 children (56% males, 44% females). Fractures were detected on 439 (46%) of the skeletal surveys, with 248 (44%) surveys showing multiple fractures. The most common locations for fractures were the long bones (n=227, 24%), skull (n=170, 18%), ribs (n=101, 11%), and clavicle (n=28, 3%). Other fractures were rare and identified in only 13 (1%) surveys. These included the spine (n=4, 0.4%), scapula (n=3, 0.3%), metacarpals (n=3, 0.3%), metatarsals (n=2, 0.2%), and pelvis (n=1, 0.1%). These fractures were isolated in only 4 (0.4%) of the surveys.

Fractures of the hands, feet, spine or pelvis are rarely detected on skeletal surveys performed for evaluation of suspected child abuse. Isolated fractures in these areas are extremely rare. The risk of additional radiation and cost of radiographs for the hands, feet, pelvis and spine may outweigh the potential marginal benefit.

Given the low yield of x-rays of the hands, feet, spine, and pelvis, the use of those views should be reconsidered in performing routine skeletal surveys for child abuse.

Lewis, M, Karmazyn, B, The Yield of the Various Radiographs in Skeletal Surveys for Suspected Child Abuse: Should ACR Practice Guidelines Change?.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008358.html