title: Radiographic skeletal survey for non-accidental injury: systematic review and development of a national New Zealand protocol.
abstract: BACKGROUND
  Clinically occult fractures from non-accidental injury (NAI) are best detected on radiographic skeletal survey. However, there are regional variations regarding the views included in such surveys. We undertook a systematic review of the evidence supporting skeletal survey protocols to design a protocol that could be implemented across New Zealand.
  
  
  METHODS
  In June 2013, we searched Medline, Google Scholar, the Cochrane database, UpToDate and relevant reference lists for English-language publications on skeletal survey in NAI from 1946. We included publications that contained a protocol or reported evidence supporting including, or excluding, specific views in a skeletal survey. All included publications were critically appraised. Based on this systematic review, a draft protocol was developed and presented to an Australian and New Zealand Society for Paediatric Radiology NAI symposium in October 2013. Feedback from the symposium and later discussions was incorporated into the final protocol.
  
  
  RESULTS
  We identified 2 guidelines for skeletal survey, 13 other protocols and 15 articles providing evidence for inclusion of specific images in a skeletal survey. The guidelines scored poorly on critical appraisal of several aspects of their methods. We found no studies that validate any of the protocols or compare their performance. Evidence supporting inclusion in a skeletal survey is limited to ribs, spine, pelvis, hands and feet, and long bone views. Our final protocol is a standardised, two-tiered protocol consisting of between 17 and 22 views.
  
  
  CONCLUSIONS
  A standardised protocol for radiographic skeletal survey protocol has been developed in New Zealand. We present it here for consideration by others.
authors.affiliation: Department of Paediatric Radiology, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: Karin L
authors.initials: KL
authors.lastname: Phillips
authors.forename: Sonja T
authors.initials: ST
authors.lastname: Bastin
authors.forename: David
authors.initials: D
authors.lastname: Davies-Payne
authors.forename: Diana
authors.initials: D
authors.lastname: Browne
authors.forename: Helen L
authors.initials: HL
authors.lastname: Bird
authors.forename: Susan
authors.initials: S
authors.lastname: Craw
authors.forename: David
authors.initials: D
authors.lastname: Duncan
authors.forename: Philippa
authors.initials: P
authors.lastname: Depree
authors.forename: Alina
authors.initials: A
authors.lastname: Leigh
authors.forename: Andrew
authors.initials: A
authors.lastname: McLaughlin
authors.forename: Russell
authors.initials: R
authors.lastname: Metcalfe
authors.forename: Jean
authors.initials: J
authors.lastname: Murdoch
authors.forename: Kirsten
authors.initials: K
authors.lastname: Pearce
authors.forename: David
authors.initials: D
authors.lastname: Perry
authors.forename: Iona
authors.initials: I
authors.lastname: Thomas
authors.forename: Glen D
authors.initials: GD
authors.lastname: Thomson
authors.forename: Sally
authors.initials: S
authors.lastname: Vogel
authors.forename: Francessa
authors.initials: F
authors.lastname: Wilson
authors.forename: Rita L
authors.initials: RL
authors.lastname: Teele
mesh_terms: D000059:Accidents; D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000517:prevention & control*; D002669:Child Welfare / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D005554:Forensic Medicine / Q000592:standards; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011859:Radiography / Q000592:standards*; D000078202:Systematic Reviews as Topic
keywords: child abuse; inflicted injury; non-accidental injury; radiography; skeletal survey; systematic review