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Duffy SO, Squires J, Fromkin JB, et al. Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys. Pediatrics. 2010;127(1):e47-52doi: 10.1542/peds.2010-0298.
Duffy, S. O., Squires, J., Fromkin, J. B., & Berger, R. P. (2011). Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys. Pediatrics, 127(1), e47-52. https://doi.org/10.1542/peds.2010-0298
Duffy, Shanna O, et al. "Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys." Pediatrics vol. 127,1 (2011): e47-52. doi: https://doi.org/10.1542/peds.2010-0298
Duffy SO, Squires J, Fromkin JB, Berger RP. Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys. Pediatrics. 2011 Jan;127(1):e47-52. doi: 10.1542/peds.2010-0298. Epub 2010 Dec 13. PMID: 21149429; PMCID: PMC4466842.
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Pediatrics. 2011 Jan;127(1):e47-52. doi: 10.1542/peds.2010-0298. Epub 2010 Dec 13.

Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys.

Pediatrics

Shanna O Duffy, Janet Squires, Janet B Fromkin, Rachel P Berger

Affiliations

  1. Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA.

PMID: 21149429 PMCID: PMC4466842 DOI: 10.1542/peds.2010-0298

Abstract

OBJECTIVES: The goals were to assess the use of the skeletal survey (SS) to evaluate for physical abuse in a large consecutive sample, to identify characteristics of children most likely to have unsuspected fractures, and to determine how often SS results influenced directly the decision to make a diagnosis of abuse.

METHODS: A retrospective, descriptive study of a consecutive sample of children who underwent an SS at a single children's hospital over 4 years was performed. Data on demographic characteristics, clinical presentation, SS results, and effects of SS results on clinical diagnoses were collected. A positive SS result was defined as a SS which identified a previously unsuspected fracture(s).

RESULTS: Of the 703 SSs, 10.8% yielded positive results. Children <6 months of age, children with an apparent life-threatening event or seizure, and children with suspected abusive head trauma had the highest rates of positive SS results. Of children with positive SS results, 79% had ≥1 healing fracture.

CONCLUSIONS: This is the largest study to date to describe the use of the SS. Almost 11% of SS results were positive. The SS results influenced directly the decision to make a diagnosis of abuse for 50% of children with positive SS results. These data, combined with the high morbidity rates for missed abuse and the large proportion of children with healing fractures detected through SS, suggest that broader use of SS, particularly for high-risk populations, may be warranted.

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