FOLLOW-UP SKELETAL SURVEYS IN SUSPECTED CHILD-ABUSE

OBJECTIVE. The purpose of this study was to assess the additional yiel d of a repeat skeletal survey in identifying and dating skeletal injur y for cases in which child abuse was strongly suspected. MATERIALS AND METHODS. Twenty-three infants and toddlers strongly suspected of bein g physically abused on the basis of findings on the initial skeletal s urvey, other imaging studies, history, or physical examination underwe nt a follow-up examination approximately 2 weeks after the initial exa mination. The high-detail imaging system included a single-emulsion, s ingle-screen combination with a low-absorption carbon-fiber cassette. The skeletal survey protocol entailed tightly collimated anteroposteri or views of the appendicular skeleton and anteroposterior and lateral views of the axial skeleton. Between the two studies, all children wer e in Department of Social Services custody or living in a safe home. R ESULTS. The follow-up skeletal survey yielded additional information r egarding skeletal injury in 14 (61%) of 23 cases. Follow-up study incr eased the number of definite fractures detected from 70 to 89 (27%) (p = .005). Most of these additional injuries were classic metaphyseal l esions or rib fractures. In 13 of the 70 fractures previously detected , the follow-up skeletal survey also provided important information ab out the age of those injuries. CONCLUSION. When child abuse is strongl y suspected on the basis of the findings on the initial skeletal surve y, other imaging studies, history, or physical examination, a follow-u p skeletal survey is recommended to provide a thorough and accurate as sessment of osseous injuries.