title: Long bone fracture detection in suspected child abuse: contribution of lateral views.
abstract: BACKGROUND
  ACR guidelines for routine skeletal survey for child abuse recommend only AP radiographs of the long bones; however, many institutions add lateral radiographs.
  
  
  OBJECTIVE
  To evaluate whether adding lateral radiographs for long bones changes the frequency and confidence of fracture detection in skeletal survey radiographs for suspected abuse.
  
  
  METHODS
  We identified 100 children younger than 2 years of age who underwent skeletal survey for child abuse; 56 with multiple long bone fractures, 22 with a single fracture and 22 with no fractures. Four radiologists (two pediatric radiologists, one pediatric radiology fellow and one general radiologist) evaluated two randomized series (one series included only frontal, and the other series, frontal and lateral radiographs). Likert scale of 1-5 was used to score for detection of metaphyseal and diaphyseal fractures.
  
  
  RESULTS
  For combined readers, significantly more metaphyseal fractures (P = 0.01) were detected with the two-views series of radiographs compared with the frontal-only view; there was no significant difference for diaphyseal fractures. Confidence was also significantly higher for the two-views series. Kappa improved (from 0.32 to 0.48) when the lateral view was added only for the metaphyseal fractures.
  
  
  CONCLUSIONS
  Adding lateral radiographs resulted in increased detection and confidence levels of metaphyseal fractures.
authors: Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, 702 Barnhill Drive, Rm. 1053, Indianapolis, IN, 46202, USA. bkarmazy@iupui.edu.
authors: Boaz
authors: B
authors: Karmazyn
authors: Kalamazoo Division, Advanced Radiology Services, Kalamazoo, MI, USA.
authors: Ryan D
authors: RD
authors: Duhn
authors: Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.
authors: S Gregory
authors: SG
authors: Jennings
authors: Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, 702 Barnhill Drive, Rm. 1053, Indianapolis, IN, 46202, USA.
authors: Matthew R
authors: MR
authors: Wanner
authors: Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.
authors: Bilal
authors: B
authors: Tahir
authors: Department of Pediatrics, Section of Child Protection Programs, Indiana University School of Medicine, Indianapolis, IN, USA.
authors: Roberta
authors: R
authors: Hibbard
authors: Department of Pediatrics, Section of Child Protection Programs, Indiana University School of Medicine, Indianapolis, IN, USA.
authors: Ralph
authors: R
authors: Hicks