title: Sensitivity of the limited view follow-up skeletal survey.
abstract: OBJECTIVE
  Reducing radiation exposure to minimize risk has been emphasized in recent years. In child abuse, the risk of missing occult injuries is often believed to outweigh radiation risk associated with skeletal surveys. Our hypothesis was that there would be no clinically significant difference in results from a limited view, follow-up skeletal survey (SS2) protocol, which omits spine and pelvis views unless these views have findings on the initial skeletal survey (SS1), compared with a traditional SS2 protocol for radiographic evaluation of suspected physical abuse.
  
  
  METHODS
  This study was a retrospective record review involving 5 child protection teams. Consultations for suspected physical abuse were reviewed to identify subjects <24 months of age who had an SS1 and a traditional SS2. The results of these studies were compared to identify subjects in which newly identified spine and pelvis fractures (fractures seen only on SS2 and not on SS1) would have been missed by using a limited view SS2 protocol.
  
  
  RESULTS
  We identified 534 study subjects. Five subjects had newly identified spine fractures, and no subjects had newly identified pelvis fractures on traditional SS2 studies. Only 1 subject with a newly identified spine fracture would have been missed with the limited view SS2 protocol used in this study (0.2% [95% confidence interval: <0.005-1.0]). None of the newly identified fractures changed the abuse-related diagnosis.
  
  
  CONCLUSIONS
  We found no clinically significant difference in the results of a limited view SS2 protocol versus a traditional SS2 protocol for radiographic evaluation of suspected abuse.
authors: Primary Children's Hospital, University of Utah, Salt Lake City, Utah; karen.hansen@imail.org.
authors: Karen Kirhofer
authors: KK
authors: Hansen
authors: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
authors: Brooks R
authors: BR
authors: Keeshin
authors: Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois;
authors: Emalee
authors: E
authors: Flaherty
authors: Children's Hospital Boston, Harvard University, Boston, Massachusetts;
authors: Alice
authors: A
authors: Newton
authors: The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and.
authors: Sarah
authors: S
authors: Passmore
authors: Intermountain Pediatric Imaging, Department of Medical Imaging, Primary Children's Hospital, Salt Lake City, Utah.
authors: Jeffrey
authors: J
authors: Prince
authors: Primary Children's Hospital, University of Utah, Salt Lake City, Utah;
authors: Kristine A
authors: KA
authors: Campbell
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D002985:Clinical Protocols; D005596:Fractures, Closed / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D010384:Pelvic Bones / Q000293:injuries*; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000000981:diagnostic imaging*
keywords: abuse; fractures; radiation; skeletal survey