title: Yield of skeletal survey by age in children referred to abuse specialists.
abstract: OBJECTIVE
  To determine rates of skeletal survey completion and injury identification as a function of age among children who underwent subspecialty evaluation for concerns of physical abuse.
  
  
  METHODS
  This was a retrospective secondary analysis of an observational study of 2609 children <60 months of age who underwent evaluation for possible physical abuse. We measured rates of skeletal survey completion and fracture identification for children separated by age into 6-month cohorts.
  
  
  RESULTS
  Among 2609 subjects, 2036 (78%) had skeletal survey and 458 (18%) had at least one new fracture identified. For all age groups up to 36 months, skeletal survey was obtained in >50% of subjects, but rates decreased to less than 35% for subjects >36 months. New fracture identification rates for skeletal survey were similar between children 24-36 months of age (10.3%, 95% CI 7.2-14.2) and children 12-24 months of age (12.0%, 95% CI 9.2-15.3) CONCLUSIONS: Skeletal surveys identify new fractures in an important fraction of children referred for subspecialty consultation with concerns of physical abuse. These data support guidelines that consider skeletal survey mandatory for all such children <24 months of age and support a low threshold to obtain skeletal survey in children as old as 36 months.
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Department of Pediatrics, Kempe Center for the Prevention and Treatment of Child Abuse, Children's Hospital of Colorado, Aurora, CO. Electronic address: daniel.lindberg@ucdenver.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Lindberg
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Berger
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Maegan S
authors.initials: MS
authors.lastname: Reynolds
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Riham M
authors.initials: RM
authors.lastname: Alwan
authors.affiliation: Driscoll Children's Hospital, Corpus Christi, TX.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Harper
mesh_terms: D000367:Age Factors; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D019221:Mandatory Reporting; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D012863:Skeleton