title: The yield of high-detail radiographic skeletal surveys in suspected infant abuse.
abstract: BACKGROUND
  Skeletal surveys are routinely performed in cases of suspected child abuse, but there are limited data regarding the yield of high-detail skeletal surveys in infants.
  
  
  OBJECTIVE
  To determine the diagnostic yield of high-detail radiographic skeletal surveys in suspected infant abuse.
  
  
  METHODS
  We reviewed the high-detail American College of Radiology standardized skeletal surveys performed for suspected abuse in 567 infants (median: 4.4 months, SD 3.47; range: 4 days-12 months) at a large urban children's hospital between 2005 and 2013. Skeletal survey images, radiology reports and medical records were reviewed. A skeletal survey was considered positive when it showed at least one unsuspected fracture.
  
  
  RESULTS
  In 313 of 567 infants (55%), 1,029 definite fractures were found. Twenty-one percent (119/567) of the patients had a positive skeletal survey with a total of 789 (77%) unsuspected fractures. Long-bone fractures were the most common injuries, present in 145 children (26%). The skull was the site of fracture in 138 infants (24%); rib cage in 77 (14%), clavicle in 24 (4.2%) and uncommon fractures (including spine, scapula, hands and feet and pelvis) were noted in 26 infants (4.6%). Of the 425 infants with neuroimaging, 154 (36%) had intracranial injury. No significant correlation between positive skeletal survey and associated intracranial injury was found. Scapular fractures and complex skull fractures showed a statistically significant correlation with intracranial injury (P = 0.029, P = 0.007, respectively).
  
  
  CONCLUSIONS
  Previously unsuspected fractures are noted on skeletal surveys in 20% of cases of suspected infant abuse. These data may be helpful in the design and optimization of global skeletal imaging in this vulnerable population.
authors.affiliation: Pediatric Radiology Department, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Av Vall d'Hebron, 119-129, Barcelona, Spain, ibarber@vhebron.net.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Barber
authors.forename: Jeannette M
authors.initials: JM
authors.lastname: Perez-Rossello
authors.forename: Celeste R
authors.initials: CR
authors.lastname: Wilson
authors.forename: Paul K
authors.initials: PK
authors.lastname: Kleinman
mesh_terms: D002649:Child Abuse / Q000175:diagnosis* / Q000517:prevention & control; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D005188:False Negative Reactions; D005260:Female; D005554:Forensic Medicine / Q000379:methods* / Q000706:statistics & numerical data; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity