Fred Lawrence Dawson MD, Abstract Co-Author: Nothing to Disclose

Boaz Karmazyn MD, Presenter: Nothing to Disclose

To compare new fracture detection between follow-up skeletal survey (SS) radiographs and bone scans in patients with suspected child abuse.

From the radiology information system, we identified all patients younger than 2 years of age who had skeletal surveys from 2003 to 2010 for child abuse and were later evaluated with both follow-up SS and technetium-99m-MDP bone scans. The radiologic reports were reviewed for new sites of fractures not identified on the first skeletal survey. Results were compared using Fisher’s exact test.

The study group included 36 patients (age range of 1 to19 months, average of 6.6 months). New fractures were detected in 20 (56%) patients by bone scan (n=18) and/or follow-up SS (n=11) (p=0.1). Additional fractures were seen only on bone scan in 10 (28%) patients, but only on follow-up SS in 2 (6%) patients (p=0.02).

New fractures were significantly more likely to be seen on bone scan than on follow-up SS radiographs.

In cases of suspected child abuse where further evaluation is needed after initial skeletal survey , we suggest bone scan rather than follow up skeletal survey for detection of new fractures.

Dawson, F, Karmazyn, B, Which Modality Should be Used to Diagnose New Fractures Not Seen on Initial Skeletal Survey for Child Abuse?.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009649.html