title: Examining the role of follow-up skeletal surveys in non-accidental trauma.
abstract: BACKGROUND
  Diagnosing NAT (non-accidental trauma) includes a skeletal survey to identify injuries. A follow-up survey is performed for missed injuries. This study examines the necessity of follow-up surveys.
  
  
  METHODS
  The trauma database identified cases of suspected NAT in <4 years olds (2013-2014). Data were stratified by survey, age, injury, then analyzed for the prevalence of findings. All analyses (relative risk, prevalence and odds ratios) utilized RealStats Resource Pack (Trento, Italy).
  
  
  RESULTS
  79% positive initial findings and no new follow up findings. Those with negative initial imaging, had no missed injuries. Initial scans were 27.6X more likely to be positive. Fractured skull (31.3), femur (17.2) and ribs (15.7) were the most prevalent. No pelvic fractures and <1% spinal injuries despite both having the greatest radiation exposure. Repeat scans rarely identify findings for age >12 months.
  
  
  CONCLUSIONS
  Follow-up skeletal surveys maybe unnecessary without clinical evidence. Uncommon pelvic and spinal fractures may warrant exclusion from surveys unless clinically indicated.
authors.affiliation: Levine Children's Hospital, Department of Pediatric Surgery and the FH "Sammy" Ross Trauma Center, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Rebecca D
authors.initials: RD
authors.lastname: Powell-Doherty
authors.affiliation: Levine Children's Hospital, Department of Pediatric Surgery and the FH "Sammy" Ross Trauma Center, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Nora E
authors.initials: NE
authors.lastname: Raynor
authors.affiliation: Levine Children's Hospital, Department of Pediatric Surgery and the FH "Sammy" Ross Trauma Center, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Donna A
authors.initials: DA
authors.lastname: Goodenow
authors.affiliation: Levine Children's Hospital, Department of Pediatric Surgery and the FH "Sammy" Ross Trauma Center, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Jacobs
authors.affiliation: Levine Children's Hospital, Department of Pediatric Surgery and the FH "Sammy" Ross Trauma Center, Carolinas Medical Center, Charlotte, NC, USA. Electronic address: Anthony.Stallion@carolinashealthcare.org.
authors.forename: Anthony
authors.initials: A
authors.lastname: Stallion
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009657:North Carolina; D017410:Practice Guidelines as Topic; D011829:Radiation Dosage; D012042:Registries; D012189:Retrospective Studies
keywords: Non-accidental trauma; Skeletal survey