title: Retrospective review to determine the utility of follow-up skeletal surveys in child abuse evaluations when the initial skeletal survey is normal.
abstract: OBJECTIVE
  The AAP recommends that a follow-up skeletal survey be obtained for all children < 24 months of age who are strongly suspected to be victims of abuse. The objective of the current study was to evaluate the utility of a follow-up skeletal survey in suspected child physical abuse evaluations when the initial skeletal survey is normal.
  
  
  METHODS
  A retrospective review of radiology records from September 1, 1998 - January 31, 2007 was conducted. Suspected victims of child abuse who were < 24 months of age and received initial and follow-up skeletal surveys within 56 days were enrolled in the study. Children with a negative initial skeletal survey were included for further analysis.
  
  
  RESULTS
  Forty-seven children had a negative initial skeletal survey and were included for analysis. The mean age was 6.9 months (SD 5.7); the mean number of days between skeletal surveys was 18.7 (SD 10.1)Four children (8.5%) had signs of healing bone trauma on a follow-up skeletal survey. Three of these children (75%) had healing rib fractures and one child had a healing proximal humerus fracture. The findings on the follow-up skeletal survey yielded forensically important information in all 4 cases and strengthened the diagnosis of non-accidental trauma.
  
  
  CONCLUSIONS
  8.5 percent of children with negative initial skeletal surveys had forensically important findings on follow-up skeletal survey that increased the certainty of the diagnosis of non-accidental trauma. A follow-up skeletal survey can be useful even when the initial skeletal survey is negative.
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio USA. Berkeley.bennett@cchmc.org.
authors.forename: Berkeley L
authors.initials: BL
authors.lastname: Bennett
authors.forename: Michael S
authors.initials: MS
authors.lastname: Chua
authors.forename: Marguerite
authors.initials: M
authors.lastname: Care
authors.forename: Andrea
authors.initials: A
authors.lastname: Kachelmeyer
authors.forename: Melinda
authors.initials: M
authors.lastname: Mahabee-Gittens