Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital
link.springer.com shows its articles on its own site.
Read the article on link.springer.com ↗Article · Jun 2020 · 1 min read
In brief
In brief
This retrospective Dutch study of 296 children under 5 years found occult fractures in 32% of suspected non-accidental trauma cases, with highest detection rates in children presenting with bruises (52%). Rib and lower leg fractures were most commonly identified on skeletal surveys.
Written by the GCMD Library team from the article.
Abstract
Purpose
The purpose of the study was to determine the rate of occult fractures (without clinical symptoms) per presenting clinical injury i.e., children presenting with a fracture, bruise, abusive head trauma and the types of fracture most likely to be found, in a series of infants and young children suspected of being victims of NAT.
Methods
Skeletal surveys done between 2008 and 2018 of children (< 5 years) were retrospectively analyzed. Both radiographs of admitted children and reassessment images from all over the country were included and reviewed by a forensic paediatric radiologist. Deceased children were excluded. Variables as gender, age, initial clinical injury and occult fractures were collected. Occult fractures on the follow-up skeletal survey were collected.
Results
A total of 370 skeletal surveys of 296 children were included. Median age was 22 weeks (IQR 11–48), there were 172 (58%) boys. A total of 195 occult fractures were detected in 111 (32%) children. Occult fractures were detected in 37/126 (29%) children with fracture as presenting symptom, 33/90 (37%) children with head trauma and 26/50 (52%) children with bruises. Rib (n = 56, 50%) and lower leg (n = 40, 36%) fractures were most detected.
Conclusion
Occult fractures were detected in 32% of the children. Occult fractures were most prevalent if the initial clinical injury suggestive for NAT to request skeletal survey was a bruise, abusive head trauma or fracture.