Follow-up skeletal survey use by child abuse pediatricians.
Skeletal survey is frequently used to identify occult fractures in young children with concern for physical abuse. Because skeletal survey is relatively insensitive for some abusive fractures, a follow-up skeletal survey (FUSS) may be undertaken at least 10-14 days after the initial skeletal survey to improve sensitivity for healing fractures. This was a prospectively planned secondary analysis of a prospective, observational study of 2,890 children who underwent subspecialty evaluation for suspected child physical abuse at 1 of 19 centers. Our objective was to determine variability between sites in rates of FUSS recommendation, completion and fracture identification among the 2,049 participants who had an initial SS. Among children with an initial skeletal survey, the rate of FUSS recommendation for sites ranged from 20% to 97%; the rate of FUSS completion ranged from 10% to 100%. Among sites completing at least 10 FUSS, rates of new fracture identification ranged from 8% to 28%. Among completed FUSS, new fractures were more likely to be identified in younger children, children with higher initial level of concern for abuse, and those with a fracture or cutaneous injury identified in the initial evaluation. The current variability in FUSS utilization is not explained by variability in occult fracture prevalence. Specific guidelines for FUSS utilization are needed.
Center for Safe and Healthy Children, Child Abuse Pediatrics, University of Minnesota Masonic Children's Hospital, East Building, M653, 2450 Riverside Avenue, Minneapolis, MN 55454, USA.
Nancy S
NS
Harper
Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, 13123 E. 16th Avenue, B390, Aurora, CO 80045, USA.
Terri
T
Lewis
Driscoll Children's Hospital, Child Abuse Resource and Evaluation Team, 3533 S Alameda, Corpus Christi, TX 78411, USA.
Sonja
S
Eddleman
Department of Emergency Medicine, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, 12401 E. 17th Avenue, B215, Aurora, CO 80045, USA.
Daniel M
DM
Lindberg
D002649:Child Abuse / Q000175:diagnosis*; D000068216:Child Protective Services / Q000379:methods; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D005596:Fractures, Closed / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies
Follow-up skeletal survey; Fracture; Physical abuse; Variability