| 1. World Health Organization. Violence against children. Available at: https://www.who.int/health-topics/violence-against-children#tab=tab_1. |
Review/Other-Dx |
N/A |
Preventing and responding to violence against children requires that efforts systematically address risk and protective factors at all four interrelated levels of risk (individual, relationship, community, society). |
No abstract available. |
4 |
| 2. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2021). Child Maltreatment 2019. Available at: https://www.acf.hhs.gov/cb/report/child-maltreatment-2019. |
Review/Other-Dx |
N/A |
Maltreatment of children. |
No abstract available. |
4 |
| 3. Loder RT, Feinberg JR. Orthopaedic injuries in children with nonaccidental trauma: demographics and incidence from the 2000 kids' inpatient database. J Pediatr Orthop 2007;27:421-6. |
Review/Other-Dx |
N/A |
To examine the demographic and injury characteristics of children hospitalized with nonaccidental trauma as a causative factor using a large national database. |
No results stated in abstract. |
4 |
| 4. Berthold O, Frericks B, John T, Clemens V, Fegert JM, Moers AV. Abuse as a Cause of Childhood Fractures. [Review]. Deutsches Arzteblatt International. 115(46):769-775, 2018 11 16. |
Review/Other-Dx |
86 articles |
To review the published literature intended for all physicians who treat children with fractures and provides an aid for deciding in which children a differentiated investigation of suspected abuse will need to be undertaken in appropriate institutions |
Fractures due to abuse are especially common among infants; their incidence is estimated at 56.8/100 000 among infants less than six months old and 39.8/100 000 among infants aged 6 to 11 months. In consideration of the age of the child, the type of fracture, the history, and other factors, a high probability of abuse can be suspected in many cases, so that further measures can be initiated. |
4 |
| 5. Flaherty EG, Perez-Rossello JM, Levine MA, et al. Evaluating children with fractures for child physical abuse. Pediatrics 2014;133:e477-89. |
Review/Other-Tx |
N/A |
To review recent advances in the understanding of fracture specificity, the mechanism of fractures, and other medical diseases that predispose to fractures in infants and children. |
No results stated in the abstract. |
4 |
| 6. Servaes S, Brown SD, Choudhary AK, et al. The etiology and significance of fractures in infants and young children: a critical multidisciplinary review. [Review]. Pediatric Radiology. 46(5):591-600, 2016 May. |
Review/Other-Dx |
N/A |
To address significant misconceptions regarding the etiology of fractures in infants and young children in cases of suspected child abuse. |
No abstract available. |
4 |
| 7. Wright JN.. CNS Injuries in Abusive Head Trauma. [Review]. AJR. American Journal of Roentgenology. 208(5):991-1001, 2017 May. |
Review/Other-Dx |
N/A |
To review the central nervous system (CNS) injuries that are characteristic of abusive head trauma (AHT) with an emphasis on pathophysiology and imaging appearance. |
HT is a frequent cause of neurologic injury in children, particularly in infants in the first year of life. Imaging evaluation plays a vital role in determining the diagnosis and prognosis. A review of the intracranial injuries that are common in AHT cases has been provided. Understanding the common patterns of abusive head injury can help increase diagnostic accuracy both by increasing recognition of injuries with a high specificity for AHT and by avoiding unwarranted concern in patients with concordant injury patterns and clinical history. |
4 |
| 8. Becker JC, Liersch R, Tautz C, Schlueter B, Andler W. Shaken baby syndrome: report on four pairs of twins. Child Abuse Negl. 1998; 22(9):931-937. |
Review/Other-Dx |
4 pairs of twins |
To describe incidence of shaken baby syndrome in four pairs of twins. |
Five children were severely affected and two died. In one family, both of the twins repeatedly suffered injury from being shaken. |
4 |
| 9. Lindberg DM, Shapiro RA, Laskey AL, Pallin DJ, Blood EA, Berger RP. Prevalence of abusive injuries in siblings and household contacts of physically abused children. Pediatrics. 2012;130(2):193-201. |
Observational-Dx |
134 contacts |
To determine the prevalence of abusive injuries identified by a common screening protocol among contacts of physically abused children. |
Protocol-indicated SS identified at least 1 abusive fracture in 16 of 134 contacts (11.9%, 95% confidence interval [CI] 7.5-18.5) <24 months of age. None of these fractures had associated findings on physical examination. No injuries were identified by neuroimaging in 19 of 25 eligible contacts (0.0%, 95% CI 0.0-13.7). Twins were at substantially increased risk of fracture relative to nontwin contacts (odds ratio 20.1, 95% CI 5.8-69.9). |
3 |
| 10. Quigley AJ, Stafrace S. Skeletal survey normal variants, artefacts and commonly misinterpreted findings not to be confused with non-accidental injury. Pediatr Radiol. 2014;44(1):82-93; quiz 79-81. |
Review/Other-Dx |
N/A |
To present a pictorial essay to aid the reporting radiologists in the differentiation between normal variants or artefacts and true traumatic injury. |
No results stated in abstract. |
4 |
| 11. Pfeifer CM, Henry MK, Care MM, et al. Debunking Fringe Beliefs in Child Abuse Imaging: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021;217:529-40. |
Review/Other-Dx |
N/A |
to provide alternative explanations in cases of suspected child abuse and reinforces the key literature and scientific consensus regarding child abuse imaging. |
No results stated in the abstract. |
4 |
| 12. American College of Radiology. ACR-SPR Practice Parameter For The Performance And Interpretation Of Skeletal Surveys In Children. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=186+&releaseId=2 |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 13. Choudhary AK, Servaes S, Slovis TL, et al. Consensus statement on abusive head trauma in infants and young children. [Review]. Pediatric Radiology. 48(8):1048-1065, 2018 08. |
Review/Other-Dx |
N/A |
To reduce confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature |
No results stated in abstract. |
4 |
| 14. Akoglu H, Celik OF, Celik A, Ergelen R, Onur O, Denizbasi A. Diagnostic accuracy of the Extended Focused Abdominal Sonography for Trauma (E-FAST) performed by emergency physicians compared to CT. American Journal of Emergency Medicine. 36(6):1014-1017, 2018 Jun.Am J Emerg Med. 36(6):1014-1017, 2018 Jun. |
Observational-Dx |
140 patients |
To compare the diagnostic accuracy of the E-FAST exam performed by EM residents with the results of CT scan as a gold standard. |
A total of 140 patients were recruited from eligible 144 patients. The final study population was 132 for abdominal and 130 for thorax examinations. In this study, AUC of E-FAST was 0.71 for abdominal free fluid, 0.87 for pneumothorax and 1.00 for pleural effusion. The sensitivity was 42.9% and specificity was 98.4%. The +LR for abdominal free fluid was 26.8 and -LR was 0.58. |
2 |
| 15. Becker A, Lin G, McKenney MG, Marttos A, Schulman CI. Is the FAST exam reliable in severely injured patients?. Injury. 41(5):479-83, 2010 May. |
Observational-Dx |
3181 patients |
To determine whether the FAST exam is reliable in severely injured patients. |
3181 patients with blunt abdominal trauma included into the study were divided into the three groups according to the ISS. The mean ISS was 7.9+/-3.97, 19.6+/-2.48 and 41.3+/-11.95 in Groups 1, 2 and 3, respectively. The accuracy of ultrasound was 90.6% in the group of patients with the highest ISS (>or=25) compared with 97.5 and 97.1 for Groups 1 and 2 (p<0.001). Similarly, ultrasound had a significantly lower sensitivity, specificity, PPV and NPV for patients in Group 3 compared with the first two groups (p<0.001). There was a significantly lower sensitivity in Group 2 compared with Group 1 (p<0.001), but no differences in specificity, accuracy, PPV or NPV were demonstrated. |
3 |
| 16. Laselle BT, Byyny RL, Haukoos JS, et al. False-negative FAST examination: associations with injury characteristics and patient outcomes. Ann Emerg Med. 60(3):326-34.e3, 2012 Sep. |
Observational-Dx |
332 patients |
To estimate associations between false-negative Focused assessment with sonography in trauma (FAST) results and patient characteristics, specific abdominalorgan injuries, and patient outcomes. |
During the study period, 332 patients met inclusion criteria. Median age was 32 years (interquartile range 23 to 45 years), 67% were male patients, the median Injury Severity Score was 27 (interquartile range 17 to 41), and 162 (49%) had a false-negative FAST result. Head injury was positively associated with false negative FAST result (odds ratio [OR] 4.9; 95% confidence interval [CI] 1.5 to 15.7), whereas severe abdominal injury was negatively associated (OR 0.3; 95% CI 0.1 to 0.5). Injuries to the spleen (OR 0.4; 95% CI 0.24 to 0.66), liver (OR 0.36; 95% CI 0.21 to 0.61), and abdominal vasculature (OR 0.17; 95% CI 0.07 to 0.38) were also negatively associated with false-negative FAST result. False-negative FAST result was not associated with mortality (OR 0.89; 95% CI 0.42 to 1.9), prolonged ICU length of stay (relative risk 0.88; 95% CI 0.69 to 1.12), or total hospital length of stay (relative risk 0.92; 95% CI 0.76 to 1.12). However, patients with false-negative FAST results were substantially less likely to require therapeutic laparotomy (OR 0.31; 95% CI 0.19 to 0.52). |
2 |
| 17. Allen CJ, Tashiro J, Sola JE. Role of FAST or Abdominal Ultrasound to Limit CT Imaging in Evaluation of the Pediatric Abdominal Trauma Patient. Current Surgery Reports 2014;2:56. |
Review/Other-Dx |
N/A |
To review the use of FAST and scoring systems as tools to limit CT imaging in the evaluation of the pediatric abdominal trauma patient. |
No results in abstract. |
4 |
| 18. Menaker J, Blumberg S, Wisner DH, et al. Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma. J Trauma Acute Care Surg 2014;77:427-32. |
Observational-Dx |
6,468 children |
To evaluate the variability of clinician-performed Focused Assessment with Sonography for Trauma (FAST) examinations and its impact on abdominal computed tomography (AbCT) use in hemodynamically stable children with blunt torso trauma (BTT). |
Of 6,468 (median age, 11.8 years; interquartile range, 6.3-15.5 years) children who met eligibility, 887 (13.7%) underwent FAST examination before CT scan. A total of 3,015 (46.6%) underwent AbCT scanning, and 373 (5.8%) were diagnosed with IAI. Use of the FAST increased as clinician suspicion for IAI increased, 11.0% with less than 1% suspicion for IAI, 13.5% with 1% to 5% suspicion, 20.5% with 6% to 10% suspicion, 23.2% with 11% to 50% suspicion, and 30.7% with greater than 50% suspicion. The patients in whom the clinicians had a suspicion of IAI of 1% to 5% or 6% to 10% were significantly less likely to undergo a CT scan if a FAST examination was performed: RR, 0.83 (0.67-1.03); RR, 0.81 (0.72-0.91); RR, 0.85 (0.78-0.94); RR, 0.99 (0.94-1.05); and RR, 0.97 (0.91-1.05) for patients with clinician suspicion of IAI of less than 1%, 1% to 5%, 6% to 10%, 11% to 50%, and greater than 50%, respectively. |
3 |
| 19. Le Coz J, Orlandini S, Titomanlio L, Rinaldi VE. Point of care ultrasonography in the pediatric emergency department. [Review]. Italian Journal of Pediatrics. 44(1):87, 2018 Jul 27.Ital. J. Pediatr.. 44(1):87, 2018 Jul 27. |
Review/Other-Dx |
N/A |
To review current knowledge on the use of POCUS in Pediatric Emergency Departments (PEDs). |
US diagnostic capacity in paediatric patients with suspected pneumonia has been studied and debated whereas literature regarding the usefulness of point-of-care echocardiography in the pediatric setting is still limited. Similarly, Focused Assessment with Sonography for Trauma (FAST) has become a standard procedure in adult emergency medicine but it is still not well codified in the pediatric practice. Concerning procedural applications of POCUS we identified 4 main groups: peripheral vascular access, bladder catheterizations, identification and drainage of abnormal fluid collections and foreign body identification. |
4 |
| 20. Holmes JF, Kelley KM, Wootton-Gorges SL, et al. Effect of Abdominal Ultrasound on Clinical Care, Outcomes, and Resource Use Among Children With Blunt Torso Trauma: A Randomized Clinical Trial. JAMA 2017;317:2290-96. |
Experimental-Dx |
460 patients received FAST; 465 patients received standard ED care |
To determine if the FAST examination during initial evaluation of injured children improves clinical care. |
Among the 925 patients who were randomized (mean [SD] age, 9.7 [5.3] years; 575 males [62%]), all completed the study. A total of 50 patients (5.4%, 95% CI, 4.0% to 7.1%) were diagnosed with intra-abdominal injuries, including 40 (80%; 95% CI, 66% to 90%) who had intraperitoneal fluid found on an abdominal CT scan, and 9 patients (0.97%; 95% CI, 0.44% to 1.8%) underwent laparotomy. The proportion of patients with abdominal CT scans was 241 of 460 (52.4%) in the FAST group and 254 of 465 (54.6%) in the standard care-only group (difference, -2.2%; 95% CI, -8.7% to 4.2%). One case of missed intra-abdominal injury occurred in a patient in the FAST group and none in the control group (difference, 0.2%; 95% CI, -0.6% to 1.2%). The mean ED length of stay was 6.03 hours in the FAST group and 6.07 hours in the standard care-only group (difference, -0.04 hours; 95% CI, -0.47 to 0.40 hours). Median hospital charges were $46 415 in the FAST group and $47 759 in the standard care-only group (difference, -$1180; 95% CI, -$6651 to $4291). |
1 |
| 21. Perez-Rossello JM, Connolly SA, Newton AW, Zou KH, Kleinman PK. Whole-body MRI in suspected infant abuse. AJR Am J Roentgenol 2010;195:744-50. |
Observational-Dx |
21 infants |
The purpose of our study was to examine the utility of whole-body MRI (WB-MRI) in the detection of skeletal and soft-tissue injuries in suspected infant abuse. |
Summary skeletal survey and WB-MRI identified 167 fractures or areas of skeletal signal abnormality: 46 (27.5%) by both techniques, 68 (40.7%) by summary skeletal survey only, and 53 (31.7%) by WB-MRI only. WB-MRI had high specificity (95%) but low sensitivity (40%) for identifying fractures or signal abnormalities compared with summary skeletal survey. Thirty-seven classic metaphyseal lesions or metaphyseal signal abnormalities were identified: 11 (29.7%) by both techniques, 24 (64.8%) by summary skeletal survey only, and two (5.4%) by WB-MRI only. WB-MRI had very low sensitivity (31%) for identifying signal abnormality where classic metaphyseal lesions were seen with skeletal survey. WB-MRI had low sensitivity (57%) for identifying signal abnormality in areas where rib fractures were seen on skeletal survey. WB-MRI identified soft-tissue injuries such as muscle edema and joint effusions that, in some cases, led to identifying additional fractures. |
2 |
| 22. Proisy M, Vivier PH, Morel B, et al. Whole-body MR imaging in suspected physical child abuse: comparison with skeletal survey and bone scintigraphy findings from the PEDIMA prospective multicentre study. Eur Radiol 2021;31:8069-80. |
Observational-Dx |
176 children |
To assess the contribution of whole-body magnetic resonance imaging (WBMRI) and bone scintigraphy (BS) in addition to skeletal survey (SS) in detecting traumatic bone lesions and soft-tissue injuries in suspected child abuse. |
One hundred seventy children were included of which sixty-four had at least one lesion. In total, 146 lesions were included. The sensitivity and specificity of each examination were, respectively, as follows: 88.4% [95% CI, 82.0-93.1] and 99.7% [95% CI, 99.5-99.8] for the SS, 69.9% [95% CI, 61.7-77.2] and 99.5% [95% CI, 99.2-99.7] for WBMRI and 54.8% [95% CI, 46.4-63.0] and 99.7% [95% CI, 99.5-99.9] for BS. Sensitivity and specificity were, respectively, 95.9% [95% CI, 91.3-98.5] and 99.2% [95% CI, 98.9-99.4] for the combination SS + WBMRI and 95.2% [95% CI, 90.4-98.1] and 99.4% [95% CI, 99.2-99.6] for the combination SS + BS, with no statistically significant difference between them. |
2 |
| 23. Lindberg DM, Stence NV, Grubenhoff JA, et al. Feasibility and Accuracy of Fast MRI Versus CT for Traumatic Brain Injury in Young Children. Pediatrics 2019;144. |
Observational-Dx |
299 participants |
To determine the feasibility and accuracy of fast MRI (motion-tolerant MRI sequences performed without sedation) in young children. |
Among 299 participants, fast MRI was available and attempted in 225 (75%) and completed in 223 (99%). Median imaging time was 59 seconds (interquartile range 52-78) for CT and 365 seconds (interquartile range 340-392) for fast MRI. TBI was identified by CT in 111 (50%) participants, including 81 skull fractures, 27 subdural hematomas, 24 subarachnoid hemorrhages, and 35 other injuries. Fast MRI identified TBI in 103 of these (sensitivity 92.8%; 95% confidence interval 86.3-96.8), missing 6 participants with isolated skull fractures and 2 with subarachnoid hemorrhage. |
2 |
| 24. Sheridan DC, Pettersson D, Newgard CD, et al. Can QuickBrain MRI replace CT as first-line imaging for select pediatric head trauma? J Am Coll Emerg Physicians Open 2020;1:965-73. |
Observational-Dx |
73 patients |
The primary objective of this trial was to evaluate the ability of a QuickBrain MRI (qbMRI) protocol to detect clinically important traumatic brain injuries in the emergency department (ED). The secondary objective of this trial was to compare qbMRI to CT in identifying radiographic traumatic brain injury. |
A total of 73 patients underwent both CT and qbMRI. The median age was 4 years (interquartile range [IQR] = 1-10 years). Twenty-two patients (30%) of patients had a clinically important traumatic brain injury, and of those, there were 2 deaths (9.1%). QbMRI acquisition time had a median of 4 minutes and 52 seconds (IQR = 3 minutes 49 seconds-5 minutes 47 seconds). QbMRI had sensitivity for detecting clinically important traumatic brain injury of 95% (95% confidence interval [CI] = 77%-99%). For any radiographic injury, qbMRI had a sensitivity of 89% (95% CI = 78%-94%). |
2 |
| 25. Berger RP, Furtado AD, Flom LL, Fromkin JB, Panigrahy A. Implementation of a brain injury screen MRI for infants at risk for abusive head trauma. Pediatric Radiology. 50(1):75-82, 2020 Jan. |
Observational-Dx |
158 patients |
To both assess the feasibility of using a previously developed magnetic resonance imaging (MRI) brain injury screen (MRBRscreen) in the acute care setting in place of head CT to identify intracranial hemorrhage in high-risk infants and to compare the accuracy of a rapid imaging pulse sequence (single-shot T2 fast spin echo [ssT2FSE]) to a conventional pulse sequence (conventional T2 fast spin echo [conT2FSE]). |
Of 158 subjects, the MRBRscreen was able to be completed in 155 (98%); 9% (14/155) were abnormal. Ninety-four percent (137/145) of subjects underwent only an MRBRscreen and avoided both radiation from head CT and sedation from MRI. The axial ssT2FSE and conT2FSE results were congruent 99% of the time. |
3 |
| 26. Bainbridge JK, Huey BM, Harrison SK. Should bone scintigraphy be used as a routine adjunct to skeletal survey in the imaging of non-accidental injury? A 10 year review of reports in a single centre. Clinical Radiology. 70(8):e83-9, 2015 Aug. |
Observational-Dx |
166 patients |
To retrospectively analyse the bone scintigraphy (BS) and skeletal survey (SS) data to evaluate the role and limitations of BS in the diagnosis of non-accidental injury (NAI). |
One hundred and sixty-six patients had both SS and BS. The findings were congruent in 74% of cases. BS added confidence to the SS findings in 8% and revealed a new abnormality in 4% of patients. BS demonstrated false-positive and -negative rates of 2% and 13%, respectively. Occult bony injury was detected in 12% of the 237 patients imaged. |
3 |
| 27. Conway JJ, Collins M, Tanz RR, et al. The role of bone scintigraphy in detecting child abuse. Semin Nucl Med. 1993; 23(4):321-333. |
Review/Other-Dx |
N/A |
Review role of bone scan in detecting child abuse. |
Major advantages of bone scan are increased sensitivity (25% to 50%) in detecting evidence of soft-tissue and bone trauma in child abuse. Radionuclide scintigraphy is a complementary rather than competitive imaging modality to X-ray evaluation in the diagnosis and management of physical child abuse. |
4 |
| 28. Drubach LA. Nuclear Medicine Techniques in Pediatric Bone Imaging. Semin Nucl Med 2017;47:190-203. |
Review/Other-Dx |
N/A |
To discuss nuclear medicine techniques for bone imaging in pediatric patients. |
No results stated in the abstract. |
4 |
| 29. Drubach LA, Johnston PR, Newton AW, Perez-Rossello JM, Grant FD, Kleinman PK. Skeletal trauma in child abuse: detection with 18F-NaF PET. Radiology 2010;255:173-81. |
Observational-Dx |
22 patients |
To evaluate the sensitivity of fluorine 18-labeled sodium fluoride ((18)F-NaF) positron emission tomography (PET) for assessment of skeletal trauma in pediatric patients suspected of having been abused and to compare the diagnostic performance of this examination with that of high-detail skeletal survey. |
A total of 156 fractures were detected at baseline skeletal survey, and 200 fractures were detected at PET. Compared with the reference standard (findings in the 14 patients who underwent baseline and follow-up skeletal survey), PET had sensitivities of 85% for the detection of all fractures, 92% for the detection of thoracic fractures (ribs, sternum, clavicle, and scapula), 93% for the detection of posterior rib fractures, and 67% for the detection of classic metaphyseal lesions (CMLs), defined as a series of microfractures across the metaphysis. Compared with the reference standard, baseline skeletal survey had sensitivities of 72% for the detection of all fractures, 68% for the detection of thoracic fractures, 73% for the detection of posterior rib fractures, and 80% for the detection of CMLs. |
3 |
| 30. Muroi A, Enomoto T, Ihara S, Ishikawa E, Inagaki T, Matsumura A. Developmental changes in the occipital cranial sutures of children less than 2 years of age. Childs Nerv Syst 2020. |
Review/Other-Dx |
167 patients |
To describe the age distribution of pediatric patients who are less than 2 years of age with occipital cranial sutures using a three-dimensional computed tomography (3D-CT). |
Based on the results of this study, various types of sutures were observed among the pediatric participants. In particular, superior median fissures, mendosal sutures, other interparietal segment's accessory sutures, and interparietal sutures were noted in 21%, 35%, 9%, and 6% of the participants, respectively. Additionally, Wormian bones within the lambdoid suture were noted in 32% of the patients. The median age of children with superior median fissure and mendosal suture was 0 month. Meanwhile, superior median fissure was not observed among children older than 5 months of age. In this population, 13 patients (8%) were found to have skull fracture. |
4 |
| 31. Sidpra J, Jeelani NUO, Ong J, Birch W, Mankad K. Skull fractures in abusive head trauma: a single centre experience and review of the literature. Childs Nerv Syst 2020. |
Review/Other-Dx |
63 patients |
To provide a comprehensive framework with which to approach paediatric calvarial injury sustained as a result of suspected abusive head trauma (AHT). |
Forty-two skull fractures were identified and described in our cohort, most of which were simple linear fractures of the parietal bones (33%). There were also a substantial number of complex stellate fractures, namely of the parietal (29%) and occipital (10%) bones. Eleven fracture mimics including accessory sutures and wormian bones were also identified in this cohort. |
4 |
| 32. Mandelstam SA, Cook D, Fitzgerald M, Ditchfield MR. Complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse. Arch Dis Child. 2003; 88(5):387-390; discussion 387-390. |
Observational-Dx |
124 bone injuries in 30 children |
Retrospective review to compare the effectiveness of radiological skeletal survey and bone scintigraphy for the detection of bony injuries in suspected child abuse cases. |
64/124 injuries were identified on bone scan and 77 on skeletal survey. Skeletal survey and bone scintigraphy are complementary studies in the evaluation of nonaccidental injury, and should both be performed in cases of suspected child abuse. |
3 |
| 33. Fernandes AR, Faria MT, Oliveira A, Barata P, Pereira J. Child Abuse: Bone Scintigraphy for the Evaluation of Non-Accidental Lesions. Acta Radiol Portusguesa 2019;31:7-10. |
Review/Other-Dx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 34. Trout AT, Strouse PJ, Mohr BA, Khalatbari S, Myles JD. Abdominal and pelvic CT in cases of suspected abuse: can clinical and laboratory findings guide its use? Pediatr Radiol. 2011; 41(1):92-98. |
Observational-Dx |
68 children |
Retrospective review was performed to identify clinical or laboratory criteria that may predict intra-abdominal injury and guide the use of abdominal and pelvic CT in this population. |
CTs were positive in 16% of patients (11/68). Hypoactive/absent bowel sounds (P=0.01, specificity?=?94.7%) and aspartate aminotransferase/alanine aminotransferase values greater than twice normal (P=0.004 and P=0.003 respectively, NPV?=?93.6%) were significantly associated with positive CTs. Multiple abnormal physical exam or laboratory findings were also significantly associated with positive CTs (P=0.03 and P=0.002 respectively, specificity?=?91.3% and NPV?=?93.6% respectively). CTs of the abdomen and pelvis are infrequently positive in cases of suspected abuse. To reduce radiation exposure, CTs should only be ordered if there are findings indicating that they may be positive. |
3 |
| 35. Karaduman D, Sarioglu-Buke A, Kilic I, Gurses E. The role of elevated liver transaminase levels in children with blunt abdominal trauma. Injury 2003;34:249-52. |
Review/Other-Dx |
87 patients |
To investigate the accuracy of these SGOT and SGPT in predicting the degree and extend of intra-abdominal and hepatic injury in children with blunt abdominal trauma |
The SGOT and SGPT of patients with and without abdominal trauma (Groups I and II) were compared. Patients with and without radiologically verified intra-abdominal injury were further compared (Groups Ib and Ia). There was significant difference in SGOT and SGPT levels of Groups I and II. SGOT and SGPT levels were 333.6+/-283.8 and, 197.5+/-192.5 U/l, respectively in Group Ib; but 84.2+/-55.9, 43+/-29.8 U/l in Group Ia (P<0.001). In all patients with radiologically detected intra-abdominal pathology SGOT and SGPT levels were above 110.5 and 63.5 U/l, respectively. In patients with hepatic injury SGOT level was above 500 U/l and, SGPT level was above 300 U/l. Statistically significant positive correlation was found between radiologically detected intra-abdominal pathology and increased SGOT (above 110.5 U/l) and SGPT (above 63.5 U/l) levels (P<0.05). These data indicated that the SGOT and SGPT levels were significantly higher in patients with intra-abdominal injury even in the absence of hepatic injury. |
4 |
| 36. Lindberg D, Makoroff K, Harper N, et al. Utility of hepatic transaminases to recognize abuse in children. Pediatrics. 2009; 124(2):509-516. |
Observational-Dx |
1,272 patients with transaminase testing; 54 identified with abdominal injuries |
To determine the sensitivity and specificity of routine transaminase testing in young children who underwent consultation for physical abuse. |
Area under the curve for the highest level of either transaminase was 0.85. Using a threshold level of 80 IU/L for either aspartate aminotransferase or alanine aminotransferase yielded a sensitivity of 77% and a specificity of 82% (positive likelihood ratio: 4.3; negative likelihood ratio: 0.3). Of injuries with elevated transaminase levels, 14 (26%) were clinically occult, lacking abdominal bruising, tenderness, and distention. Several clinical findings used to predict abdominal injury had high specificity but low sensitivity. In the population of children with concern for physical abuse, abdominal injury is an important cause of morbidity and mortality, but it is not so common as to warrant universal imaging. Abdominal imaging should be considered for potentially abused children when either the aspartate aminotransferase or alanine aminotransferase level is >80 IU/L or with abdominal bruising, distention, or tenderness. |
3 |
| 37. Christian CW, Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse. Pediatrics. 135(5):e1337-54, 2015 May. |
Review/Other-Dx |
N/A |
To discuss the evaluation of suspected child physical abuse. |
No results stated in the abstract. |
4 |
| 38. Goodwin SJ, Flanagan SG, McDonald K. Imaging of Chest and Abdominal Trauma in Children. [Review]. Current Pediatric Review. 11(4):251-61, 2015.Curr. Pediatr. Rev.. 11(4):251-61, 2015. |
Review/Other-Dx |
N/A |
To explain the imaging findings in chest and abdominal trauma. |
No results in abstract. |
4 |
| 39. Raissaki M, Veyrac C, Blondiaux E, Hadjigeorgi C. Abdominal imaging in child abuse. Pediatr Radiol 2011;41:4-16; quiz 137-8. |
Review/Other-Dx |
N/A |
To review abdominal imaging in child abuse. |
No results listed in abstract. |
4 |
| 40. Pomeranz CB, Barrera CA, Servaes SE. Value of chest CT over skeletal surveys in detection of rib fractures in pediatric patients. Clin Imaging 2022;82:103-09. |
Observational-Dx |
57 patients |
The purpose of this study was to evaluate the sensitivity of skeletal survey radiographs at diagnosis of rib fractures compared to computed tomography (CT) in the pediatric population. Although smaller studies have examined a similar question in the pediatric population, this is the largest study to date comparing skeletal survey radiographs to CT in living patients. |
This retrospective review included 57 patients who had undergone both a SS and a CT chest or CT chest/abdomen/pelvis within 30 days of each other for the indication of either non-accidental (NAT) or accidental trauma between 2009 and 2017. Images and reports were analyzed by a pediatric radiology fellow for presence/absence of fracture, evidence of healing and location of rib fracture, including rib level, location within the rib (anterior, lateral, and posterior), and side (right versus left). 225 rib fractures were identified in 25 patients on CT. 38 of those fractures were missed on the preceding SS, yielding a miss rate of 17%. Acute fractures were more likely to be missed than chronic or healing fractures (p = 0.01). Location within the rib did not impact rib detection on radiographs. Left-sided rib fractures were not more common in NAT patients, compared to accidental trauma. SS miss approximately 17% of all rib fractures and CT is more sensitive modality in the detection of rib fractures, particularly acute rib fractures, regardless of location. Low-dose Chest CT could be a helpful modality in the work-up of NAT trauma. |
3 |
| 41. Sanchez TR, Lee JS, Coulter KP, Seibert JA, Stein-Wexler R. CT of the chest in suspected child abuse using submillisievert radiation dose. Pediatric Radiology. 45(7):1072-6, 2015 Jul.Pediatr Radiol. 45(7):1072-6, 2015 Jul. |
Observational-Dx |
4 children |
To determine if CT of the chest in suspected child abuse using nsubmillisievert radiation dose is more useful in the evaluation of high specificity fractures of non-accidental trauma when the four-view chest radiographs are negative. |
We retrospectively identified four children (three boys, one girl; age range 1-4 months) admitted between January 2013 and February 2014 with high suspicion for non-accidental trauma from unexplained fractures of the long bones; these children all had CT of the chest when no rib fractures were evident on the skeletal survey. The absorbed radiation dose estimates for organs and tissue from the four-view chest radiographs and subsequent CT were determined using Monte Carlo photon transport software, and the effective dose was calculated using published tissue-weighting factors. In two children, CT showed multiple fractures of the ribs, scapula and vertebral body that were not evident on the initial skeletal survey. The average effective dose for a four-view chest radiograph across the four children was 0.29 mSv and the average effective dose for the chest CT was 0.56 mSv. Therefore the effective dose of a chest CT is on average less than twice that of a four-view chest radiograph. |
4 |
| 42. Holl EM, Marek AP, Nygaard RM, Richardson CJ, Hess DJ. Use of Chest Computed Tomography for Blunt Pediatric Chest Trauma: Does It Change Clinical Course?. Pediatric Emergency Care. 36(2):81-86, 2020 Feb.Pediatr Emerg Care. 36(2):81-86, 2020 Feb. |
Review/Other-Dx |
127 patients |
To determine if chest CT changes clinical course for blunt pediatric chest trauma. |
Of the 127 patients identified, 64.6% had no discrepancy between their initial CR and chest CT and 35.4% of the children's imaging contained a discrepancy. The majority of the pediatric and general trauma surgeons felt CT was indicated in 6 of 45 patients based on CR. In 87% of patients with a discrepancy in findings on CR and CT, the majority of surgeons agreed that their management would not change based on the additional information. In the 6 patients in which the CT was considered indicated, 4 of the 6 would have triggered a management change. |
4 |
| 43. Kemp AM, Dunstan F, Harrison S, et al. Patterns of skeletal fractures in child abuse: systematic review. BMJ 2008;337:a1518. |
Review/Other-Dx |
32 studies |
To systematically review published studies to identify the characteristics that distinguish fractures in children resulting from abuse and those not resulting from abuse, and to calculate a probability of abuse for individual fracture types. |
In total, 32 studies were included. Fractures resulting from abuse were recorded throughout the skeletal system, most commonly in infants (<1 year) and toddlers (between 1 and 3 years old). Multiple fractures were more common in cases of abuse. Once major trauma was excluded, rib fractures had the highest probability for abuse (0.71, 95% confidence interval 0.42 to 0.91). The probability of abuse given a humeral fracture lay between 0.48 (0.06 to 0.94) and 0.54 (0.20 to 0.88), depending on the definition of abuse used. Analysis of fracture type showed that supracondylar humeral fractures were less likely to be inflicted. For femoral fractures, the probability was between 0.28 (0.15 to 0.44) and 0.43 (0.32 to 0.54), depending on the definition of abuse used, and the developmental stage of the child was an important discriminator. The probability for skull fractures was 0.30 (0.19 to 0.46); the most common fractures in abuse and non-abuse were linear fractures. Insufficient comparative studies were available to allow calculation of a probability of abuse for other fracture types. |
4 |
| 44. Maguire S, Cowley L, Mann M, Kemp A. What does the recent literature add to the identification and investigation of fractures in child abuse: an overview of review updates 2005-2013. Evidence-Based Child Health: A Cochrane Review Journal 2013;8:2044-57. |
Review/Other-Dx |
N/A |
No abstract available. |
No abstract available. |
4 |
| 45. Wootton-Gorges SL, Stein-Wexler R, Walton JW, Rosas AJ, Coulter KP, Rogers KK. Comparison of computed tomography and chest radiography in the detection of rib fractures in abused infants. Child Abuse Negl. 2008;32(6):659-663. |
Observational-Dx |
12 abused infants |
To compare CT and CXR in the evaluation of rib fractures in abused infants. |
The mean patient age was 2.5 months (1.2-5.6), with seven females and five males. While 131 fractures were visualized by CT, only 79 were seen by CXR (p<.001). One patient had fractures only seen by CT. There were significantly (p<.05) more early subacute (24 vs. 4), subacute (47 vs. 26), and old fractures (4 vs. 0) seen by CT than by CXR. Anterior (42 vs. 11), anterolateral (21 vs. 12), posterolateral (9 vs. 3) and posterior (39 vs. 24) fractures were better seen by CT than by CXR (p<.01). Bilateral fractures were detected more often by CT (11) than by CXR (6). |
2 |
| 46. Shelmerdine SC, Langan D, Hutchinson JC, et al. Chest radiographs versus CT for the detection of rib fractures in children (DRIFT): a diagnostic accuracy observational study. The Lancet Child & Adolescent Health. 2(11):802-811, 2018 11. |
Observational-Dx |
25 cases |
To compare the accuracy of post-mortem chest radiography and CT for the detection of rib fractures in children, with autopsy data as reference standard. |
25 cases of children (aged 1 month to 7 years), with 136 rib fractures at autopsy with paired post-mortem chest radiographs and CTs, were selected for analysis. 38 radiologists were recruited as reporters from 23 international centres; 12 (32%) were consultants, median experience of 14·5 years (range 6-27), and 26 (68%) were registrars, median experience of 4 years (range 2-9). Across all radiologists, three times as many rib fractures were correctly detected by use of chest CTs compared with chest radiography (sensitivity 44·9% [95% CI 31·7-58·9] vs 13·5% [8·1-21·5]; difference 31·4% [23·3-37·8; p<0·001]). Sensitivity for detection on the correct rib was higher by use of CT than by use of radiography (62·4% [95% CI 44·9-77·1] vs 23·1% [12·9-37·8]; difference 39·3% [31·9-42·2; p<0·001]), as was diagnosis of a patient with any rib fracture or fractures (81·5% [75·8-86·0] vs 64·7% [57·3-71·4]; difference 16·7% [11·5-22·2; p<0·001]). Radiologist confidence was higher when using CT images than radiographs (highest confidence rating given on 3317 [63·6%] of 5218 fractures for CT vs 1518 [46·6%] of 3303 on radiographs) and was a predictor for accurate fracture detection. |
2 |
| 47. Boehnke M, Mirsky D, Stence N, Stanley RM, Lindberg DM. Occult head injury is common in children with concern for physical abuse. Pediatric Radiology. 48(8):1123-1129, 2018 08. |
Observational-Dx |
1143 patients |
To determine the prevalence of occult head injury in a large patient cohort with suspected physical abuse using similar selection criteria from previous studies. Additionally, we evaluated proposed risk factors for associations with occult head injury. |
One thousand one hundred forty-three subjects met inclusion criteria and 62.5% (714) underwent neuroimaging with either head computed tomography or magnetic resonance imaging. We found an occult head injury prevalence of 19.7% (141). Subjects with emesis (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8-6.8), macrocephaly (OR 8.5, 95% CI 3.7-20.2), and loss of consciousness (OR 5.1, 95% CI 1.2-22.9) had higher odds of occult head injury. |
3 |
| 48. Fickenscher KA, Dean JS, Mena DC, Green BA, Lowe LH. Occult cranial injuries found with neuroimaging in clinically asymptomatic young children due to abusive compared to accidental head trauma. South Med J 2010;103:121-5. |
Observational-Dx |
58 children |
To compare occult brain injuries on neuroimaging in clinically asymptomatic children under 20 months due to abusive versus accidental head trauma. |
The disposition of 31 subjects was abusive trauma and 27 were accidental. At presentation, 8/31(25.8%) children with abusive injury and 15/27(55.6%) with accidental injury were neurologically asymptomatic. Neuroimaging was abnormal in 6 of 8 (75.0%) asymptomatic children with abusive injury, and 13/15 (86.7%) children with accidental trauma. No significant (P = 0.59) difference in frequency of abnormal neuroimaging was seen between the asymptomatic abusive and accidental trauma groups. |
3 |
| 49. Harper NS, Feldman KW, Sugar NF, Anderst JD, Lindberg DM. Additional injuries in young infants with concern for abuse and apparently isolated bruises. J Pediatr. 2014;165(2):383-388 e381. |
Review/Other-Dx |
2890 children |
To determine the prevalence of additional injuries or bleeding disorders in a large population of young infants evaluated for abuse because of apparently isolated bruising. |
Among 2890 children, 33.9% (980/2890) were <6 months old, and 25.9% (254/980) of these had bruises identified. Within this group, 57.5% (146/254) had apparently isolated bruises at presentation. Skeletal surveys identified new injury in 23.3% (34/146), neuroimaging identified new injury in 27.4% (40/146), and abdominal injury was identified in 2.7% (4/146). Overall, 50% (73/146) had at least one additional serious injury. Although testing for bleeding disorders was performed in 70.5% (103/146), no bleeding disorders were identified. Ultimately, 50% (73/146) had a high perceived likelihood of abuse. |
4 |
| 50. Laskey AL, Holsti M, Runyan DK, Socolar RR. Occult head trauma in young suspected victims of physical abuse. J Pediatr. 2004;144(6):719-722. |
Review/Other-Dx |
51 patients |
To determine the frequency of neuroimaging and ophthalmology consults in children evaluated for physical abuse without neurologic symptoms and the diagnostic yield of these studies. |
51 patients had a skeletal survey and no clinical signs of ICI. 75% of patients had CT or MRI; 69% had formal evaluation for retinal hemorrhages. 29% had evidence of ICI without neurologic symptoms. Age less than 12 months was the only factor significantly associated with neuroimaging (90% vs 55%, P=.004). Sex, race, insurance, and having an unrelated male caretaker were not significantly associated with performance of neuroimaging or findings of ICI. |
4 |
| 51. Rubin DM, Christian CW, Bilaniuk LT, Zazyczny KA, Durbin DR. Occult head injury in high-risk abused children. Pediatrics. 2003;111(6 Pt 1):1382-1386. |
Review/Other-Dx |
65 patients |
To estimate the prevalence of occult head injury in a high-risk sample of abused children with normal neurologic examinations and to describe characteristics of this population. |
Of the 65 patients, 51 (78.5%) had a head CT or MRI in addition to skeletal survey. Of these 51 patients, 19 (37.3%, 95% CI, 24.2%-50.4%) had an occult head injury. Injuries included scalp swelling (74%), skull fracture (74%), and ICI (53%). All except 3 of the head-injured patients had at least a skull fracture or ICI. Skeletal survey alone missed 26% (5/19) of the cases. Head-injured children were younger than non-head-injured children (median age 2.5 vs 5.1 months); all but 1 head-injured child was <1 year of age. Among the head-injured children, 72% came from single parent households, 37% had mothers whose age was <21 years, and 26% had a history of prior child welfare involvement in their families. Ophthalmologic examination was performed in 14/19 cases; no retinal hemorrhages were noted. |
4 |
| 52. Bradford R, Choudhary AK, Dias MS. Serial neuroimaging in infants with abusive head trauma: timing abusive injuries. J Neurosurg Pediatrics. 12(2):110-9, 2013 Aug. |
Review/Other-Dx |
105 infants |
To analyze a larger group of 210 cases involving infants with AHT to chronicle the first appearance and evolution of radiological (CT, MRI) abnormalities. |
One hundred five infants with specific injury dates and available imaging studies were identified; a subset of 43 children additionally had documented times of injury. In infants with homogeneously hyperdense subdural hematomas (SDHs) on initial CT scans, the first hypodense component appeared within the SDH between 0.3 and 16 days after injury, and the last hyperdense subdural component disappeared between 2 and 40 days after injury. In infants with mixed-density SDHs on initial scans, the last hyperdense component disappeared between 1 and 181 days. Parenchymal hypodensities appeared on CT scans performed as early as 1.2 hours, and all were visible within 27 hours after the injury. Rebleeding into SDHs was documented in 17 cases (16%) and was always asymptomatic. Magnetic resonance imaging of the brain was performed in 49 infants. Among those with SDH, 5 patterns were observed. Patterns I and II reflected homogeneous SDH; Pattern I (T1 hyperintensity and T2/FLAIR hypointensity, "early subacute") more commonly appeared on scans performed earlier after injury compared with Pattern II (T1 hyperintensity and T2/FLAIR hyperintensity, "late subacute"), although there was considerable overlap. Patterns III and IV reflected heterogeneous SDH; Pattern III contained relatively equal mixtures having different intensities, whereas Pattern IV had fluid that was predominantly T1 hypointense and T2/FLAIR hyperintense. Again, Pattern III more commonly appeared on scans performed earlier after injury compared with Pattern IV, although there was significant overlap. |
4 |
| 53. Wittschieber D, Karger B, Pfeiffer H, Hahnemann ML. Understanding Subdural Collections in Pediatric Abusive Head Trauma. [Review]. Ajnr: American Journal of Neuroradiology. 40(3):388-395, 2019 03. |
Review/Other-Dx |
N/A |
To shed light on subdural collections in children with abusive head trauma and aim at providing a recent knowledge base for various medical disciplines involved in diagnostic procedures and legal proceedings. |
No results in abstract. |
4 |
| 54. Sieswerda-Hoogendoorn T, Postema FA, Verbaan D, Majoie CB, van Rijn RR. Age determination of subdural hematomas with CT and MRI: a systematic review. Eur J Radiol. 2014;83(7):1257-1268. |
Review/Other-Dx |
22 studies |
To systematically review the literature on dating subdural hematomas (SDHs) on CT and MRI scans. |
We included 22 studies describing 973 SDHs on CT and 4 studies describing 83 SDHs on MRI. Data from 17 studies (413 SDHs) could be pooled. There were significant differences between time intervals for the different densities on CT (p<0.001). Time interval differed significantly between children and adults for iso- and hypodensity (p=0.000) and hyperdensity (p=0.046). Time interval did not differ significantly between abused and non-abused children. On MRI, time intervals for different signal intensities on T1 and T2 did not differ significantly (p=0.108 and p=0.194, respectively). |
4 |
| 55. Choudhary AK, Bradford R, Dias MS, Thamburaj K, Boal DK. Venous injury in abusive head trauma. Pediatric Radiology. 45(12):1803-13, 2015 Nov. |
Observational-Dx |
45 children |
To define the incidence and characteristics of venous and sinus abnormalities in abusive head trauma. |
A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. |
2 |
| 56. Palifka LA, Frasier LD, Metzger RR, Hedlund GL. Parenchymal Brain Laceration as a Predictor of Abusive Head Trauma. Ajnr: American Journal of Neuroradiology. 37(1):163-8, 2016 Jan. |
Review/Other-Dx |
137 patients |
To investigate whether a specific imaging finding, parenchymal brain laceration, is unique to children diagnosed with abusive head trauma. |
Among the abusive head trauma cohort, parenchymal brain lacerations were identified in 18 patients, while none were identified in any patients with accidental injury. |
4 |
| 57. Ronning MM, Carolan PL, Cutler GJ, Patterson RJ. Parasagittal vertex clots on head CT in infants with subdural hemorrhage as a predictor for abusive head trauma. Pediatric Radiology. 48(13):1915-1923, 2018 12. |
Observational-Dx |
99 patients |
To describe parasagittal vertex clots on head computed tomography (CT) in infants with SDH and AHT compared to patients with SDH and accidental trauma, and to evaluate for parasagittal vertex clots in the absence of SDH in the setting of known accidental head trauma. |
Ninety-nine patients were eligible for analysis. Mean age was 4 months. Fifty-seven (57.6%) were male. Fifty-five (55.6%) patients were identified as having AHT and 22 (22.2%) had accidental trauma. Forty-five (81.2%) patients with AHT had parasagittal vertex clots present on CT scan compared to 8 (36.4%) patients with accidental trauma. Compared to patients without parasagittal vertex clots, those with parasagittal vertex clots were more likely to have AHT (66.2% vs. 32.3%, P=0.001), no known mechanism of injury (69.1% vs. 32.3%, P=0.015), retinal hemorrhage (75% vs. 35.5%, P=0.002) and hypoxic-ischemic changes (25% vs. 0%, P=0.002). Patients with parasagittal vertex clots have eight times the odds of AHT compared to patients without parasagittal vertex clots. Age-matched control patients who underwent head CT scan due to a history of accidental head injury without SDH were identified (n=87); no patient in the control group had parasagittal vertex clots. |
3 |
| 58. Teixeira SR, Goncalves FG, Servin CA, Mankad K, Zuccoli G. Ocular and Intracranial MR Imaging Findings in Abusive Head Trauma. [Review]. Topics in Magnetic Resonance Imaging. 27(6):503-514, 2018 Dec. |
Review/Other-Dx |
N/A |
No purpose stated in abstract. |
No results stated in abstract. |
4 |
| 59. Vazquez E, Delgado I, Sanchez-Montanez A, Fabrega A, Cano P, Martin N. Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging?. [Review]. Pediatr Radiol. 44 Suppl 4:S589-603, 2014 Dec. |
Review/Other-Dx |
N/A |
To present a review of the use and clinical indications of the most pertinent neuroimaging modalities for the diagnosis of abusive head trauma, emphasizing the newer and more sensitive techniques that may be useful to better characterize the nature and evolution of the injury. |
No results in abstract. |
4 |
| 60. Zimmerman RA, Bilaniuk LT, Farina L. Non-accidental brain trauma in infants: diffusion imaging, contributions to understanding the injury process. J Neuroradiol 2007;34:109-14. |
Review/Other-Dx |
33 infants |
To report on the findings of MRI diffusion to reveal patterns of injury |
No results stated in abstract. |
4 |
| 61. Choudhary AK, Jha B, Boal DK, Dias M. Occipital sutures and its variations: the value of 3D-CT and how to differentiate it from fractures using 3D-CT? Surg Radiol Anat 2010;32:807-16. |
Review/Other-Dx |
N/A |
To describe the normal anatomy, embryology, normal and variant sutures of occipital bone as published in the literature so far and present a pictorial review of 15 cases of variant sutures. |
No results stated in abstract. |
4 |
| 62. Langford S, Panigrahy A, Narayanan S, et al. Multiplanar reconstructed CT images increased depiction of intracranial hemorrhages in pediatric head trauma. Neuroradiology. 57(12):1263-8, 2015 Dec. |
Observational-Dx |
215 cases |
To evaluate unenhanced head CTs in pediatric trauma patients to investigate the various benefits of multiplanar reconstructed images (MPR) in this age group. |
MPR improved the detection of hemorrhage in 14 cases (6.5 %, p-value < 0.01) and incidental findings in five cases (2.3 %, p-value < 0.05) as well as helped prove artifacts in five cases (2.3 %, p-value < 0.05). |
4 |
| 63. Orman G, Wagner MW, Seeburg D, et al. Pediatric skull fracture diagnosis: should 3D CT reconstructions be added as routine imaging? J Neurosurg Pediatr 2015;16:426-31. |
Observational-Dx |
250 patients |
To compare the efficacy of combining 2D+3D CT reconstructions with standard 2D CT images in the diagnosis of linear skull fractures in children with head trauma. |
Included in the study were 250 consecutive CT studies of 250 patients (167 boys and 83 girls). The mean age of the children was 7.82 years (range 4 days to 17.4 years). 2D+3D CT combined had a higher sensitivity and specificity (83.9% and 97.1%, respectively) compared with 2D alone (78.2% and 92.8%, respectively) with statistical significance for specificity (p < 0.05) in children less than 2 years of age. 2D+3D CT combined had a higher sensitivity and specificity (81.3% and 90.5%, respectively) compared with 2D alone (74.5% and 89.1%, respectively) with statistical significance for sensitivity (p < 0.05) in all children. |
3 |
| 64. Prabhu SP, Newton AW, Perez-Rossello JM, Kleinman PK. Three-dimensional skull models as a problem-solving tool in suspected child abuse. Pediatr Radiol. 2013;43(5):575-581. |
Review/Other-Dx |
73 children |
To assess the value of 3-D skull models as a problem-solving tool in children younger than 2 years. |
Of the 73 children, volume-rendered 3-D models were obtained in 26 (35.6%). 3-D models changed initial CT interpretation in 9 instances (34.6%). Findings thought to be fractures were confirmed as normal variants in 4 children. Depressed fractures were correctly shown to be ping-pong fractures in 2 cases. In 1 case, an uncertain finding was confirmed as a fracture, and an additional contralateral fracture was identified in 1 child. A fracture seen on skull radiographs but not seen on axial CT images was identified on the 3-D model in 1 case. Changes in interpretation led to modification in management in 5 children. |
4 |
| 65. Kelly P, John S, Vincent AL, Reed P. Abusive head trauma and accidental head injury: a 20-year comparative study of referrals to a hospital child protection team. Archives of Disease in Childhood. 100(12):1123-30, 2015 Dec. |
Review/Other-Dx |
345 children |
To describe children referred for suspected abusive head trauma (AHT) to a hospital child protection team in Auckland, New Zealand. |
Records were available for 345 children. Referrals increased markedly (88 in the first decade, 257 in the second), but the diagnostic ratio was stable: AHT 60%, accidental or natural 29% and uncertain cause 11%. The probability of AHT was similar regardless of socio-economic status or ethnicity. In children under 2 years old with accidental head injuries (75/255, 29%) or AHT (180/255, 71%), characteristics of particular interest for AHT included no history of trauma (88/98, 90%), no evidence of impact to the head (84/93, 90%), complex skull fractures with intracranial injury (22/28, 79%), subdural haemorrhage (160/179, 89%) and hypoxic ischaemic injury (38/39, 97%). In children over 2 years old, these characteristics did not differ significantly between children with accidental head injuries (21/47, 45%) and AHT (26/47, 55%). The mortality of AHT was higher in children over 2 years old (10/26, 38%) than under 2 years (19/180, 11%). |
4 |
| 66. Buttram SD, Garcia-Filion P, Miller J, et al. Computed tomography vs magnetic resonance imaging for identifying acute lesions in pediatric traumatic brain injury. Hosp. pediatr.. 5(2):79-84, 2015 Feb. |
Observational-Dx |
105 children |
To compare lesion detection between CT and MRI after TBI. |
One hundred five children were studied. Of these, 78% had mild TBI. The MRI scan was obtained a median of 1 day (interquartile range, 1-2) after CT. Overall, CT and MRI demonstrated poor agreement (?=-0.083; P=.18). MRI detected a greater number of intraparenchymal lesions (n=36; 34%) compared with CT (n=16; 15%) (P<.001). Among patients with abusive head trauma, MRI detected intraparenchymal lesions in 16 (43%), compared with only 4 (11%) lesions with CT (P=.03). Of 8 subjects with a normal CT scan, 6 out of 8 had abnormal lesions on MRI. |
3 |
| 67. Roguski M, Morel B, Sweeney M, et al. Magnetic resonance imaging as an alternative to computed tomography in select patients with traumatic brain injury: a retrospective comparison. J Neurosurg Pediatrics. 15(5):529-34, 2015 May. |
Observational-Dx |
30 patients |
To evaluate the sensitivity of Magnetic Resonance Imaging (MRI) in the setting of acute Traumatic head injury (THI) |
The mean age of the 30-patient cohort was 8.5 ± 6.7 years, and 63.3% were male. The mean Injury Severity Score was 13.7 ± 9.2, and the mean Glasgow Coma Scale score was 9 ± 5.7. Radiology reports noted 150 abnormal findings. CT scanning missed findings in 12 patients; the missed findings included DAI (n = 5), subarachnoid hemorrhage (n = 6), small subdural hematomas (n = 6), cerebral contusions (n = 3), and an encephalocele. The CT scan was negative in 3 patients whose subsequent MRI revealed findings. MRI missed findings in 13 patients; missed findings included skull fracture (n = 5), small subdural hematomas (n = 4), cerebral contusions (n = 3), subarachnoid hemorrhage (n = 3), and DAI (n = 1). MRI was negative in 1 patient whose preceding CT scan was read as positive for injury. Although MRI more frequently reported intracranial findings than CT scanning, there was no statistically significant difference between CT and MRI in the detection of any intracranial injury (p = 0.63), DAI (p = 0.22), or intracranial hemorrhage (p = 0.25). CT scanning tended to more frequently identify skull fractures than MRI (p = 0.06). |
2 |
| 68. Dremmen MHG, Wagner MW, Bosemani T, et al. Does the Addition of a "Black Bone" Sequence to a Fast Multisequence Trauma MR Protocol Allow MRI to Replace CT after Traumatic Brain Injury in Children? AJNR Am J Neuroradiol 2017;38:2187-92. |
Observational-Dx |
28 children |
To evaluate the role of MR imaging, including a "black bone" sequence, compared with CT in detecting skull fractures and intracranial hemorrhages in children with acute head trauma. |
Twenty-eight children (24 boys; mean age, 4.89 years; range, 0-15.5 years) with head trauma were included. MR imaging with the black bone sequence revealed lower sensitivity (66.7% versus 100%) and specificity (87.5% versus 100%) in identifying skull fractures. Four of 6 incorrectly interpreted black bone MR imaging studies showed cranial sutures being misinterpreted as skull fractures and vice versa. |
3 |
| 69. Kralik SF, Supakul N, Wu IC, et al. Black bone MRI with 3D reconstruction for the detection of skull fractures in children with suspected abusive head trauma. Neuroradiology. 61(1):81-87, 2019 Jan. |
Observational-Dx |
34 patients |
To determine the accuracy of "black bone" (BB) MRI for the detection of skull fractures in children with potential abusive head trauma. |
Median patient age was 4 months (range 1.2-30 months). A total of 20 skull fractures in six patients (18% incidence of skull fractures) were detected on HCT. BB demonstrated 83% sensitivity (95%[CI] 36-99%), 100% specificity (95%[CI] 88-100%), 100% PPV (95%[CI] 46-100%), 97% NPV (95%[CI] 82-99%), and 97% accuracy (95%[CI] 85-99%) for diagnosis of a skull fracture. BB detected 95% (19/20) of the skull fractures detected by CT. |
3 |
| 70. Hahnemann ML, Kinner S, Schweiger B, et al. Imaging of bridging vein thrombosis in infants with abusive head trauma: the "Tadpole Sign". European Radiology. 25(2):299-305, 2015 Feb. |
Review/Other-Dx |
628 infants |
To investigate the incidence, radiological characteristics and non-radiological co-factors of bridging vein thrombosis (BVT) in infants with AHT. |
SDHs and/or SDHys were present in 29 of the 81 cases exhibiting morphological abnormalities in the initial CT. Among these, 11 cases (40%) had BVT (mean age = 5.0 months). BVT could be best depicted in the T1-weighted spin echo and T2*/susceptibility-weighted MRI. In one case, BVT could be depicted indirectly using time-of-flight MR venography. The predominant (73%) BVT shape was found to be tadpole-like ("Tadpole Sign"). |
4 |
| 71. Orru' E, Huisman TAGM, Izbudak I. Prevalence, Patterns, and Clinical Relevance of Hypoxic-Ischemic Injuries in Children Exposed to Abusive Head Trauma. J Neuroimaging. 28(6):608-614, 2018 11. |
Review/Other-Dx |
57 patients |
To determine: (a) prevalence, types, and clinical relevance of cytotoxic edema compatible with HII in nonpenetrating AHT, (b) their relationship to other classic neuroimaging findings of AHT, and (c) their correlation with clinical outcomes. |
Out of 57 patients, 36.8% showed lesions compatible with HII. A predominantly asymmetric cortical distribution was observed in 66.7% of cases, while 33.3% had diffused both cortical and deep gray/white matter distribution injury. Traumatic axonal injuries and focal contusions were less common. There was no significant correlation between the presence of SDH (P = .6) or skull fractures (P = .53) and HII. HII was the most severe form of parenchymal damage in terms of in-hospital mortality and morbidity at follow-up. |
4 |
| 72. Rambaud C.. Bridging veins and autopsy findings in abusive head trauma. [Review]. Pediatric Radiology. 45(8):1126-31, 2015 Jul. |
Review/Other-Dx |
N/A |
Bridging veins are crucial for the venous drainage of the brain. |
No results stated in abstract. |
4 |
| 73. Kemp AM, Rajaram S, Mann M, et al. What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review. Clin Radiol. 2009; 64(5):473-483. |
Review/Other-Dx |
18 studies; 367 children |
Systematic review to examine the optimal neuroradiological investigation strategy to identify inflicted brain injury. |
Combining MRI with an abnormal early CT revealed additional information in 25% (95% CI: 18.3%-33.16%) of children. Optimal imaging strategy involves initial CT, followed by early MRI and diffusion-weighted imaging if early CT examination is abnormal, or there are ongoing clinical concerns. |
4 |
| 74. Porto L, Bartels MB, Zwaschka J, et al. Abusive head trauma: experience improves diagnosis. Neuroradiology 2021;63:417-30. |
Observational-Dx |
25 children |
Our goal was to determine whether non-neuroradiologists with standard neuroradiology knowledge perform as well as neuroradiologists with experience in pediatric neuroimaging in interpreting magnetic resonance imaging (MRI) in cases of presumptive abusive head trauma (pAHT). |
Blindly, neuroradiologists demonstrated higher levels of sensitivity and positive predictive value in the diagnosis of pAHT (89%) than non-neuroradiologists (50%). Neuroradiologists chose correctly pAHT as the most probable diagnosis 16 out of 18 times; in contrast, non-neuroradiologists only chose 9 out of 18 times. In our series, the foremost important misdiagnosis for pAHT was NAHT (neuroradiologists twice and non-neuroradiologists 5 times). Only victims of motor vehicle accidents were blindly misdiagnosed as pAHT. No usual household NAHT was not misdiagnosed as pAHT. Neuroradiologists correctly ruled out pAHT in all cases of metabolic diseases and BESS. |
2 |
| 75. Vilanilam GK, Jayappa S, Desai S, Zuccoli G, Ramakrishnaiah RH, Choudhary AK. Venous injury in pediatric abusive head trauma: a pictorial review. Pediatr Radiol 2021;51:918-26. |
Review/Other-Dx |
N/A |
To review the traumatic subdural hematoma as well as various morpho-structural patterns of shearing injuries and thrombosis of intracranial bridging veins. |
No results stated in the abstract. |
4 |
| 76. Burtard C, Panks J, Silverman LB, et al. Prevalence of cerebral sinovenous thrombosis in abusive head trauma. Pediatr Radiol 2023;53:78-85. |
Review/Other-Dx |
243 patients |
To determine the prevalence of cerebral sinovenous thrombosis (CSVT) and subdural hemorrhage (SDH) in a large abusive head trauma (AHT) population. |
Among 243 patients diagnosed with AHT, 7% (16/243) had CSVT. SDH was present in 94% (15/16) of the CSVT cases. Cytotoxic edema and subarachnoid hemorrhage were in 88% (14/16) and 69% (11/16) of the CSVT cases, respectively. Extracranial signs of abuse were also in 100% (16/16) of the patients with CSVT. Critical to maximal head injury severity (abbreviated injury scale >=5) was in 75% (12/16) of the CSVT population vs. 33% (82/243) in the total AHT population. Length of hospital and pediatric intensive care unit stay was greater in those with CSVT (10 vs. 21.9 and 3.5 vs. 7.3 days). |
4 |
| 77. Murphy R, Kelly DM, Moisan A, et al. Transverse fractures of the femoral shaft are a better predictor of nonaccidental trauma in young children than spiral fractures are. Journal of Bone & Joint Surgery - American Volume. 97(2):106-11, 2015 Jan 21. |
Observational-Dx |
122 patients |
To determine whether femoral fracture morphology, as determined by an objective measurement (fracture ratio), was indicative of nonaccidental trauma in young children. |
Of 122 patients identified, ninety-five met the inclusion criteria for this study. Of these ninety-five, fifty-one (54%) had either a Child Protective Services or a Child Assessment Program consultation because of suspected nonaccidental trauma. Thirteen (25%) were found to have nonaccidental trauma as determined by Child Protective Services or the Child Assessment Program team and seven (14%) had indeterminate Child Protective Services or Child Assessment Program investigations. All thirteen patients with nonaccidental trauma, as well as the seven patients with an indeterminate Child Protective Services or Child Assessment Program investigation, had positive Modified Maltreatment Classification System scores for physical abuse. Patients who had nonaccidental trauma had significantly decreased mean anteroposterior fracture ratios compared with those who had confirmed accidental trauma (p < 0.0001). |
3 |
| 78. Rosado N, Ryznar E, Flaherty EG. Understanding humerus fractures in young children: Abuse or not abuse?. Child Abuse & Neglect. 73:1-7, 2017 Nov. |
Review/Other-Dx |
97 patients |
To understand humerus fractures in young children as abuse or not abuse. |
The 97 eligible patients had 100 humerus fractures. The most common fracture location was the distal humerus (65%) and the most common fracture type was supracondylar (48%). Child Protection Teams evaluated 44 patients (45%) and determined that 24 of those had 25 fractures caused by abuse (25% of the total study population).Among children with fractures determined to have been caused by abuse, the most common location was the distal humerus (50%) and the most common types were transverse and oblique (25% each); however, transverse and oblique fractures were also seen in patients whose injuries were determined to have been non-abusive. A younger age, non-ambulatory developmental stage, and the presence of additional injuries were significantly associated with abusive fractures. |
4 |
| 79. Ryznar E, Rosado N, Flaherty EG. Understanding forearm fractures in young children: Abuse or not abuse?. Child Abuse & Neglect. 47:132-9, 2015 Sep. |
Review/Other-Dx |
135 patients |
To understand forearm fractures in young children as abuse or not abuse. |
The 135 included patients sustained 216 forearm fractures. Most were buckle (57%) or transverse (26%). Child protection teams evaluated 47 (35%) of the patients and diagnosed 11 (23%) as having fractures caused by abuse. Children with abusive versus non-inflicted injuries had significant differences in age (median age 7 versus 12 months), race, and presence of additional injuries. Children with abusive forearm fractures often presented without an explanation or a changing history for the injury. Children with non-inflicted forearm fractures often presented after a fall. No particular type of forearm fracture was specific for child abuse. Any forearm fracture in a young child should be evaluated with special attention to the details of the history and the presence of other injuries. Young age, additional injuries, and an absent or inconsistent explanation should increase concern that the fracture was caused by child abuse. |
4 |
| 80. Kleinman PK, Perez-Rossello JM, Newton AW, Feldman HA, Kleinman PL. Prevalence of the classic metaphyseal lesion in infants at low versus high risk for abuse. AJR Am J Roentgenol 2011;197:1005-8. |
Review/Other-Dx |
42 infants |
To determine the relative likelihood of encountering a classic metaphyseal lesion in infants at low and high risk for abuse |
There were 42 low-risk infants (age range, 0.4-12 months; mean age, 4.4 months) and 18 high-risk infants (age range, 0.8-10.3 months; mean age, 4.6 months). At least one classic metaphyseal lesion was identified in nine infants (50%) in the high-risk category. No classic metaphyseal lesions were identified in the low-risk group. The relative prevalence of classic metaphyseal lesions in the low-risk group (0/42) versus that in the high-risk group (9/18) was statistically significant (p < 0.0001; 95% CI, 0-8% to 29-76%). |
4 |
| 81. Paine CW, Fakeye O, Christian CW, Wood JN. Prevalence of Abuse Among Young Children With Rib Fractures: A Systematic Review. Pediatric Emergency Care. 35(2):96-103, 2019 Feb. |
Review/Other-Dx |
10 articles (1396 children) |
To estimate the prevalence of abuse in young children presenting with rib fractures and to identify demographic, injury, and presentation-related characteristics that affect the probability that rib fractures are secondary to abuse. |
Data for 1396 children 48 months or younger with rib fractures were abstracted from 10 articles. Among infants younger than 12 months, abuse prevalence ranged from 67% to 82%, whereas children 12 to 23 and 24 to 35 months old had study-specific abuse prevalences of 29% and 28%, respectively. Age younger than 12 months was the only characteristic significantly associated with increased likelihood of abuse across multiple studies. Rib fracture location was not associated with likelihood of abuse. The retrospective design of the included studies and variations in ascertainment of cases, inclusion/exclusion criteria, and child abuse assessments prevented further meta-analysis. |
4 |
| 82. Barber I, Perez-Rossello JM, Wilson CR, Silvera MV, Kleinman PK. Prevalence and relevance of pediatric spinal fractures in suspected child abuse. Pediatr Radiol. 43(11):1507-15, 2013 Nov. |
Review/Other-Dx |
751 children |
To establish the prevalence of spinal fractures detected on skeletal surveys performed for suspected child abuse and their association with intracranial injury (ICI). |
Fourteen children had a total of 22 definite spinal fractures. This constituted 1.9% (14/751) of the total cohort, and 9.7% (14/145) of children with a positive skeletal survey. Advanced imaging confirmed the fractures in 13 of the 14 children and demonstrated 12 additional spinal fractures. In five cases, spinal fractures were the only positive skeletal findings. In 71% (10/14) of the children, the spinal fractures were accompanied by ICI. Children with spinal fractures were at significantly greater risk for ICI than those without spinal injury (P < 0.05). |
4 |
| 83. Kogutt MS, Swischuk LE, Fagan CJ. Patterns of injury and significance of uncommon fractures in the battered child syndrome. Am J Roentgenol Radium Ther Nucl Med 1974;121:143-9. |
Review/Other-Dx |
100 children |
To review the case histories and roentgenogram in children and to document the patterns of injury |
No abstract available. |
4 |
| 84. Shaw J, Simonton K. Pediatric Fractures: Identifying and Managing Physical Abuse. Clinical Pediatric Emergency Medicine 2020:[In Press]. |
Review/Other-Dx |
N/A |
To review current knowledge on the topic of child abuse considerations when children present with fractures. |
No results stated in abstract. |
4 |
| 85. Lindberg DM, Berger RP, Reynolds MS, Alwan RM, Harper NS. Yield of skeletal survey by age in children referred to abuse specialists. J Pediatr. 2014;164(6):1268-1273 e1261. |
Observational-Dx |
2609 children |
To determine rates of skeletal survey completion and injury identification as a function of age among children who underwent subspecialty evaluation for concerns of physical abuse. |
Among 2609 subjects, 2036 (78%) had skeletal survey and 458 (18%) had at least one new fracture identified. For all age groups up to 36 months, skeletal survey was obtained in >50% of subjects, but rates decreased to less than 35% for subjects >36 months. New fracture identification rates for skeletal survey were similar between children 24-36 months of age (10.3%, 95% CI 7.2-14.2) and children 12-24 months of age (12.0%, 95% CI 9.2-15.3) |
3 |
| 86. Paine CW, Wood JN. Skeletal surveys in young, injured children: A systematic review. Child Abuse & Neglect. 76:237-249, 2018 02. |
Review/Other-Dx |
32 articles |
To describe the utilization patterns (percentages of children who are evaluated), yield (percentages of children with occult fractures detected), and risks of obtaining SS in young, injured children through a systematic review of the literature. |
Data from 32 articles represents 64,983 children <60months old. SS utilization was high (85%-100%) in studies of infants evaluated by a child protection team for suspected abuse and/or diagnosed with abuse except in one study of primarily non-pediatric hospitals. Greater variability in SS utilization was observed across studies that included all infants with specific injuries, such as femur fractures (0%-77%), significant head injury (51%-82%), and skull fractures (41%-86%). Minority children and children without private insurance were evaluated with SS more often than white children and children with private insurance despite lack of evidence to support this practice. Among children undergoing SS, occult fractures were frequently detected among infants with significant head injury (23%-34%) and long bone fractures (30%) but were less common in infants with skull fractures (1%-6%). |
4 |
| 87. Ravichandiran N, Schuh S, Bejuk M, et al. Delayed identification of pediatric abuse-related fractures. Pediatrics 2010;125:60-6. |
Review/Other-Dx |
258 patients |
To determine how frequently abusive fractures were missed by physicians during previous examinations. A secondary objective was to determine clinical predictors that are associated with unrecognized abuse. |
Of 258 patients with abusive fractures, 54 (20.9%) had at least 1 previous physician visit at which abuse was missed. The median time to correct diagnosis from the first visit was 8 days (minimum: 1; maximum: 160). Independent predictors of missed abuse were male gender, extremity versus axially located fracture, and presentation to a primary care setting versus pediatric emergency department or to a general versus pediatric emergency department. |
4 |
| 88. Meshaka R, Garbera DM, Arthurs OJ, Shelmerdine SC. Value of additional lateral radiographs in paediatric skeletal surveys for suspected physical abuse. Clin Radiol 2022;77:e40-e47. |
Review/Other-Dx |
138 skeletal surveys |
To determine the added value of lateral limb radiographs in suspected physical abuse (SPA), particularly with regard to fracture detection and reporter confidence. |
One hundred and thirty-eight skeletal surveys (29 live, 109 deceased children) were assessed, consisting of 16 appendicular fractures imaged in two projections (six wrist, five knee, five ankle). In the majority of cases (14/16) the fractures were already visible on the frontal view with only two fractures (one distal radius, one distal tibial) identified only by lateral projection on the blinded review. One fracture (distal tibia) was visible only on the frontal radiograph (not lateral view). The addition of lateral projection did not lead to overcalling of fractures in the remaining normal studies. Radiologist confidence scores showed an improvement with the addition of a lateral projection when a study was thought to be normal (p=0.001-0.003), but not when a fracture was identified (p>0.05). |
4 |
| 89. Benya EC, Lim-Dunham JE, Landrum O, Statter M. Abdominal sonography in examination of children with blunt abdominal trauma. AJR Am J Roentgenol 2000;174:1613-6. |
Observational-Dx |
51 patients |
The objective of our study was to evaluate abdominal sonography for the detection of fluid and organ injury in children with blunt abdominal trauma. |
In 33.3% of patients, CT revealed fluid, organ injury, or both. The sensitivity and specificity of sonography when detection of fluid was the sole parameter evaluated was 58.8% and 79.4%, respectively, for observer 1 and 47.1% and 79.4%, respectively, for observer 2. In contrast, the sensitivity and specificity of sonography when detection of both fluid and organ injury was evaluated was 64.7% and 79.4%, respectively, for observer 1 and 70.6% and 70.6%, respectively, for observer 2. The negative predictive value of sonography was 79.4% and 75.0% with evaluation limited to detection of fluid and 81.8% and 82.8% with evaluation of fluid and organ abnormality for observers 1 and 2 , respectively. Agreement was excellent for sonographic identification of fluid (kappa = 0.82) but poor for detection of organ injury (kappa = 0.34). |
2 |
| 90. Trinci M, Piccolo CL, Ferrari R, Galluzzo M, Ianniello S, Miele V. Contrast-enhanced ultrasound (CEUS) in pediatric blunt abdominal trauma. J Ultrasound 2019;22:27-40. |
Review/Other-Dx |
N/A |
To review contrast-enhanced ultrasound (CEUS) in pediatric blunt abdominal trauma. |
No results stated in the abstract. |
4 |
| 91. Armstrong LB, Mooney DP, Paltiel H, et al. Contrast enhanced ultrasound for the evaluation of blunt pediatric abdominal trauma. J Pediatr Surg 2018;53:548-52. |
Observational-Dx |
18 children |
This study aims to determine the sensitivity and specificity of contrast enhanced ultrasound (CEUS) compared to computed tomography (CT) in the evaluation of children with blunt abdominal trauma. |
Twenty one injured organs were identified by CT in eighteen children. Conventional US identified the injuries with a sensitivity of 45.2%, which increased to 85.7% using CEUS. The specificity of conventional US was 96.4% and increased to 98.6% using CEUS. The positive predictive value increased from 79.2% to 94.7% and the negative predictive value from 85.3% to 95.8%. Two patients had injuries that were missed by both radiologists on CEUS. In a 100kg, 17year old female, a grade III liver injury was not seen by either radiologist on CEUS. Her accompanying grade I kidney injury was not seen by one of the radiologist on CEUS. The second patient, a 16year old female, had a grade III splenic injury that was missed by both radiologists on CEUS. She also had an adjacent grade II kidney injury that was seen by both. Injuries, when noted, were graded within 1 grade of CT 33/35 times with CEUS. There were no adverse reactions to the contrast. |
2 |
| 92. Paltiel HJ, Barth RA, Bruno C, et al. Contrast-enhanced ultrasound of blunt abdominal trauma in children. Pediatr Radiol 2021;51:2253-69. |
Review/Other-Dx |
N/A |
To discuss the current experience using contrast-enhanced ultrasound (CEUS) for evaluating pediatric blunt abdominal trauma, emphasizing examination technique and imaging findings of major abnormalities associated with injuries of the liver, spleen, kidneys, adrenal glands, pancreas and testes. And to also present the limitations of the technique and offer a review of the major literature on this topic in both children and adults. |
No results stated in the acbstract. |
4 |
| 93. Pinto F, Valentino M, Romanini L, Basilico R, Miele V. The role of CEUS in the assessment of haemodynamically stable patients with blunt abdominal trauma. [Review]. Radiol Med (Torino). 120(1):3-11, 2015 Jan. |
Review/Other-Dx |
N/A |
To discuss the role of contrast-enhanced US (CEUS) in the assessment of haemodynamically stable patients with blunt abdominal trauma. |
No results stated in the abstract. |
4 |
| 94. Elkhunovich M, Sirody J, McCormick T, Goodarzian F, Claudius I. The Utility of Cranial Ultrasound for Detection of Intracranial Hemorrhage in Infants. Pediatr Emerg Care 2018;34:96-101. |
Observational-Dx |
238 patients |
The objective of this study was to evaluate the sensitivity and specificity of cranial ultrasound (CUS) for detection of intracranial hemorrhage (ICH) in infants with open fontanels. |
Of 4948 CUS studies performed during the 5-year study period, 283 studies fit the inclusion criteria. Patient age ranged from 0 to 458 days, with a median of 33 days. There were 39 total cases of ICH detected, with 27 significant bleeds and 12 insignificant bleeds. Using computed tomography, magnetic resonance imaging, or clinical outcome as criterion standard, the overall ultrasound sensitivity and specificity for bleed were 67% (confidence interval [CI], 50%-81%) and 99% (CI, 97%-100%), respectively. For those with significant bleeds, the overall sensitivity was 81% (CI, 62%-94%), and for those with insignificant bleeds, it was 33% (CI, 1%-65%). |
3 |
| 95. Peter C, Stranzinger E, Heverhagen JT, et al. Minor head trauma in infants - how accurate is cranial ultrasound performed by trained radiologists? Eur J Pediatr 2023;182:3113-20. |
Observational-Dx |
325 patients |
The aim of the presented study is to determine the diagnostic accuracy of cranial ultrasound (CUS) in detecting skull fracture (SF) and/or intracranial hemorrhage (ICH) among infants with minor head trauma. With the hypothesized high accuracy, CUS could give reassurance to reduce the time of clinical observation because of the decreased risk of clinically important traumatic brain injury (ciTBI). |
An inconspicuous CUS followed by an uneventful clinical course would allow exclusion of ciTBI with a great certainty. This monocentric, retrospective, observational study analyzed CUS in infants (<?12 months) after minor head trauma at Bern University Children’s Hospital, between 7/2013 and 8/2020. The primary outcome was the sensitivity and specificity of CUS in detecting SF and/or ICH by comparison to the clinical course and to additional neuroimaging. Out of a total of 325 patients, 73% (n?=?241) had a normal CUS, 17% (n?=?54) were found with SF, and ICH was diagnosed in 2.2% patients (n?=?7). Two patients needed neurosurgery and three patients deteriorated clinically during surveillance. Additional imaging was performed in 35 patients. The sensitivity of CUS was 93% ([0.83, 0.97] 95% CI) and the specificity 98% ([0.95, 0.99] 95% CI). All false-negative cases originated in missed SF without clinical deterioration; no ICH was missed. |
3 |
| 96. Belfer RA, Klein BL, Orr L. Use of the skeletal survey in the evaluation of child maltreatment. Am J Emerg Med 2001;19:122-4. |
Review/Other-Dx |
203 children |
(1) to determine the incidence of clinically unsuspected fractures detected by skeletal survey, and (2) to identify high-risk groups of children who would benefit from skeletal surveys. |
There were 96 skeletal surveys performed; of these, 25 were positive for at least 1 clinically unsuspected fracture. Eighty percent of occult fractures were found in children younger than 1 year old. Presenting with a new fracture or an intracranial injury placed the child at higher risk of occult fracture. In contrast, patients with burn injuries had a very low yield of occult fractures. The patient's age and type of suspicious injury can help guide the physician as to when to obtain a skeletal survey. |
4 |
| 97. Kemp AM. Fractures in physical child abuse. Paediatrics and Child Health 2008;18:550-53. |
Review/Other-Dx |
N/A |
To identify some of the features that can be used to differentiate abusive fractures from the greater numbers of childhood fractures that are sustained from accidental trauma. Current investigation strategies and diagnostic dilemmas are discussed. |
No results in abstract. |
4 |
| 98. McNamara CR, Panigrahy A, Sheetz M, Berger RP. The Likelihood of an Occult Fracture in Skeletal Surveys Obtained in Children More Than 2 Years Old With Concerns of Physical Abuse. Pediatr Emerg Care 2022;38:e488-e92. |
Observational-Dx |
325 patients |
To compare the number of skeletal surveys (SS) obtained in children more than 2 years of age after the implementation of the order set compared with a 5-year period before the order set, calculate the proportion of SS which identified occult fracture(s) in the 2 time periods, and determine whether certain patient characteristics were associated with a higher rate of occult fractures. |
There were 325 skeletal surveys, a marked increase in the rate of skeletal surveys compared with before order set implementation. Less than 2% (6/325) of skeletal surveys demonstrated an occult fracture. Of the 6 patients with occult fractures, 4 were physically abused; in each case, the diagnosis of abuse was evident before the skeletal survey. The other 2 patients fell from windows. The radiation exposure was 0.34 mSv. |
3 |
| 99. Choudhary AK, Bradford RK, Dias MS, Moore GJ, Boal DK. Spinal subdural hemorrhage in abusive head trauma: a retrospective study. Radiology. 2012;262(1):216-223. |
Review/Other-Dx |
252 children |
To compare the relative incidence, distribution, and radiologic characteristics of spinal subdural hemorrhage after abusive head trauma versus that after accidental trauma in children. |
In the abusive head trauma cohort, 67 (26.5%) of 252 children had evaluable spinal imaging results. Of these, 38 (56%) of 67 children had undergone thoracolumbar imaging, and 24 (63%) of 38 had thoracolumbar subdural hemorrhage. Spinal imaging was performed in this cohort 0.3-141 hours after injury (mean, 23 hours +/- 27 [standard deviation]), with 65 (97%) of 67 cases having undergone imaging within 52 hours of injury. In the second cohort with accidental injury, only one (1%) of 70 children had spinal subdural hemorrhage at presentation; this patient had displaced occipital fracture. The comparison of incidences of spinal subdural hemorrhage in abusive head trauma versus those in accidental trauma was statistically significant (P < .001). |
4 |
| 100. Choudhary AK, Ishak R, Zacharia TT, Dias MS. Imaging of spinal injury in abusive head trauma: a retrospective study.[Erratum appears in Pediatr Radiol. 2015 Apr;45(5):784; PMID: 25794487]. Pediatr Radiol. 44(9):1130-40, 2014 Sep. |
Review/Other-Dx |
183 children |
To compare the relative incidence of spinal ligamentous and soft-tissue abnormalities on spinal MRI among three groups of children ages <48 months: 1) those with AHT, 2) those with accidental trauma, and 3) those with nontraumatic conditions. |
Cervical spine ligamentous injuries (predominantly the nuchal, atlanto-occipital and atlanto-axial ligaments) were present in 78% of the AHT group, 46% of the accidental trauma group and 1% of the nontraumatic group; all of these differences were statistically significant. Among the AHT group, ligamentous injuries were statistically correlated with evidence of brain ischemia. |
4 |
| 101. Kadom N, Khademian Z, Vezina G, Shalaby-Rana E, Rice A, Hinds T. Usefulness of MRI detection of cervical spine and brain injuries in the evaluation of abusive head trauma. Pediatr Radiol. 44(7):839-48, 2014 Jul. |
Review/Other-Dx |
74 children |
To determine both the incidence and the spectrum of cervical spine and brain injuries in children being evaluated for possible AHT. Article also examined the relationship between cervical and brain MRI findings and selected study outcome categories. |
Study outcomes were categorized as: n = 26 children with accidental head trauma, n = 38 with AHT (n = 18 presumptive AHT, n = 20 suspicious for AHT), and n = 10 with undefined head trauma. The authors found cervical spine injuries in 27/74 (36%) children. Most cervical spine injuries were ligamentous injuries. One child had intrathecal spinal blood and 2 had spinal cord edema; all 3 of these children had ligamentous injury. MRI signs of cervical injury did not show a statistically significant relationship with a study outcome of AHT or help discriminate between accidental and AHT. Of the 30 children with supratentorial brain injury, 16 (53%) had a bilateral hypoxic-ischemic pattern. There was a statistically significant relationship between bilateral hypoxic-ischemic brain injury pattern and AHT (P<0.05). In addition, the majority (81%) of children with bilateral hypoxic-ischemic brain injuries had cervical injuries. |
4 |
| 102. Rabbitt AL, Kelly TG, Yan K, Zhang J, Bretl DA, Quijano CV. Characteristics associated with spine injury on magnetic resonance imaging in children evaluated for abusive head trauma. Pediatric Radiology. 50(1):83-97, 2020 Jan. |
Review/Other-Dx |
76 children |
To assess the incidence of spine injury on MRI in children evaluated for AHT, and to correlate spine MRI findings with clinical characteristics. |
Forty-five of 76 (59.2%) children had spine injury. Spine injury was associated with more severe injury (longer intensive care stays [P<0.001], lower initial mental status [P=0.01] and longer ventilation times [P=0.001]). Overall abuse likelihood and spine injury were not associated. Spinal subdural hemorrhage was the only finding associated with a combination of retinal hemorrhages (P=0.01), noncontact head injuries (P=0.008) and a diagnosis of AHT (P<0.05). Spinal subdural hemorrhage was associated with other spine injury (P=0.004) but not with intracranial hemorrhage (P=0.28). |
4 |
| 103. Karmazyn B, Lewis ME, Jennings SG, Hibbard RA, Hicks RA. The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change? AJR Am J Roentgenol. 2011;197(1):W159-163. |
Review/Other-Dx |
930 children |
To evaluate the prevalence and site of fractures detected on skeletal surveys performed for suspected child abuse at a tertiary children's hospital and to determine whether any survey images may be eliminated without affecting clinical care or the ability to make a diagnosis. |
Nine hundred thirty children (515 boys and 415 girls) with a median age of 6 months met the entry criteria for the study. Fractures were detected in 317 children (34%), of whom 166 (18%) had multiple fractures. The most common sites for fractures were the long bones (21%), ribs (10%), skull (7%), and clavicle (2%). Ten children (1%) had fractures in the spine (n = 3), pelvis (n = 1), hands (n = 6), and feet (n = 2). All 10 children had other signs of physical abuse. |
4 |
| 104. Kleinman PK, Morris NB, Makris J, Moles RL, Kleinman PL. Yield of radiographic skeletal surveys for detection of hand, foot, and spine fractures in suspected child abuse. AJR Am J Roentgenol. 200(3):641-4, 2013 Mar. |
Observational-Dx |
365 studies |
To assess the prevalence of fractures of the spine, hands, and feet in cases of suspected child abuse on ACR-standardized skeletal surveys acquired near the end of the film-screen era. |
Twenty of 365 studies (5.5%) yielded fractures involving the spine, hands, or feet. Of all positive skeletal surveys, 8.9% (20/225) had fractures involving the spine, hands, or feet. Of all patients with more than one fracture on skeletal survey, 20.4% (20/98) had fractures involving these regions. |
4 |
| 105. Lindberg DM, Harper NS, Laskey AL, Berger RP, ExSTRA Investigators. Prevalence of abusive fractures of the hands, feet, spine, or pelvis on skeletal survey: perhaps "uncommon" is more common than suggested. Pediatr Emerg Care. 29(1):26-9, 2013 Jan. |
Review/Other-Dx |
2049 skeletal surveys |
To describe the prevalence of fractures to the hands, feet, spine, or pelvis among skeletal surveys obtained for children in a large, multicenter population who underwent consultation for physical abuse. |
Among 2049 initial SSs, 471 (23.0%) showed at least 1 previously unknown fracture including 49 (10.4%) that showed a fracture to the hands, feet, spine, or pelvis. In 10 cases, the SS identified at least 1 fracture of the hands, feet, spine, or pelvis when no other fractures were identified. |
4 |
| 106. Canty KW, Feldman KW, Bartnik-Olson B, Choudhary AK, Shiroishi MS, Group ECAW. Current issues and controversies surrounding spine imaging and the significance of spinal subdural hemorrhage in suspected abusive head trauma. Pediatr Radiol 2022;52:2445-49. |
Review/Other-Dx |
N/A |
To explain current issues and controversies surrounding spine imaging and the significance of spinal subdural hemorrhage in suspected abusive head trauma. |
No abstract available. |
4 |
| 107. Karmazyn B, Reher TA, Supakul N, et al. Whole-Spine MRI in Children With Suspected Abusive Head Trauma. AJR Am J Roentgenol 2022;218:1074-87. |
Observational-Dx |
256 children |
The purpose of this study was to evaluate whether whole-spine magnetic resonance imaging (MRI) in children with suspected abusive head trauma (AHT) shows additional abnormalities not identified on cervical spine MRI. |
A total of 148 of 256 (57.8%) children underwent whole-spine MRI. AHT was diagnosed in 79 of 148 (53.4%) children who underwent whole-spine MRI versus in 2 of 108 (1.9%) who did not undergo whole-spine MRI (p < .001). Interobserver agreement, expressed as kappa coefficient, was 0.90 for intraspinal hemorrhage, 0.69 for ligamentous injury, 0.66 for spinal cord edema, and 0.95 for fracture. A total of 57 of 148 (38.5%) whole-spine MRI examinations showed injuries, and 34 of 148 (23.0%) showed injuries localized to the thoracolumbar spine. A total of 47 of 148 (31.8%) whole-spine MRI examinations showed major findings, of which 24 (51.1%) were localized to the thoracolumbar spine. Isolated thoracolumbar injuries included 23 of 34 spinal subdural hematomas, 2 of 3 spinal epidural hematomas, and 9 of 11 vertebral fractures, including five fractures not identified by skeletal survey. Diagnosis of AHT was more common in children with positive, versus negative, whole-spine MRI examinations (76.8% vs 39.1%; p < .001). |
2 |
| 108. Deye KP, Berger RP, Lindberg DM, Ex SI. Occult abusive injuries in infants with apparently isolated skull fractures. J Trauma Acute Care Surg 2013;74:1553-8. |
Review/Other-Dx |
215 infants |
To determine rates of screening, rates of injury identification, and rates of reporting to child protective services among infants who underwent subspecialty evaluation for abuse after presenting with an apparently isolated skull fracture. |
A total of 215 infants underwent abuse consultation for apparently isolated skull fractures. Skeletal surveys were performed in 201 subjects (93.4%) and identified additional fractures in 12 (5.6%; 95% confidence interval, 2.9-9.6%). Patient age, trauma history, and fracture type (simple/complex) were not sensitive predictors of finding additional fractures on skeletal survey. Only one additional fracture was associated with clinical signs or symptoms. Dedicated ophthalmologic examination was undertaken in 100 subjects (46.5%); one child had retinal hemorrhages. Hepatic transaminases were obtained in 135 subjects (62.7%), and 5 subjects (2.3%) had abdominal computed tomography. No abdominal injuries were identified. A total of 146 subjects (67.9%) were reported to child protective services. |
4 |
| 109. Feldman KW, Tayama TM, Strickler LE, et al. A Prospective Study of the Causes of Bruises in Premobile Infants. Pediatr Emerg Care 2020;36:e43-e49. |
Review/Other-Dx |
63 infants |
To determine the behavior of physicians evaluating premobile infants with bruises. Second, and most importantly, to learn whether infants with unexplained bruising who had been initially evaluated by primary care and emergency department (ED) physicians are as likely to have their bruises attributed to child abuse as those children evaluated by child abuse physicians. |
Between March 1, 2010, and March 1, 2017, 63 infants with initially explained and 46 infants with initially unexplained bruises were identified. Infants with unexplained bruises had complete coagulation and abuse evaluations less frequently if they were initially identified by primary care pediatricians or ED providers than by CAPs. After imaging, laboratory, and follow-up, 54.2% (26) of the infants with initially unexplained bruises, including 2 who had been initially diagnosed with accidental injuries, were diagnosed as abused. Three (6.2%) infants had accidental bruising, 6 (12.4%) abuse mimics, 1 (2.5%) self-injury, 1 (2.5%) medical injury, and 11 (22.9%) remained of unknown causation. None had causal coagulation disorders. A total of 65.4% of the 26 abused infants had occult injuries detected by their imaging and laboratory evaluations. Six (23.1%) abused infants were not diagnosed until after they sustained subsequent injuries. Three (11.5%) were recognized abused by police investigation alone. Thirty-eight percent of the abused, bruised infants had a single bruise. Clinicians' estimates of abuse likelihood based on their initial clinical evaluation were inaccurate. Primary care, ED, and child abuse physicians identified abused infants at similar rates. |
4 |
| 110. Kemp AM, Dunstan F, Nuttall D, Hamilton M, Collins P, Maguire S. Patterns of bruising in preschool children--a longitudinal study. Archives of Disease in Childhood. 100(5):426-31, 2015 May. |
Observational-Dx |
328 children |
To identify the prevalence and pattern of bruises in preschool children over time, and explore influential variables. |
3523 bruises recorded from 2570 data collections from 328 children (mean age 19 months); 6.7% of 1010 collections from premobile children had at least one bruise (2.2% of babies who could not roll over and 9.8% in those who could), compared with 45.6% of 478 early mobile and 78.8% of 1082 walking child collections. The most common site affected in all groups was below the knees, followed by 'facial T' and head in premobile and early mobile. The ears, neck, buttocks, genitalia and hands were rarely bruised (<1% of all collections). None of gender, season or the level of social deprivation significantly influenced bruising patterns, although having a sibling increased the mean number of bruises. There was considerable variation in the number of bruises recorded between different children which increased with developmental stage and was greater than the variation between numbers of bruises in collections from the same child over time. |
3 |
| 111. Rosenfeld EH, Johnson B, Wesson DE, Shah SR, Vogel AM, Naik-Mathuria B. Understanding non-accidental trauma in the United States: A national trauma databank study. J Pediatr Surg 2020;55:693-97. |
Review/Other-Dx |
678,503 children |
To characterize the epidemiology, injury patterns, outcomes and trends of non-accidental trauma (NAT) in the United States using a large national database. |
Of 678,503 children admitted for traumatic injuries, 3% (19,149) were victims of NAT. The majority (95%) were under 5 years and 71% under 1 year old. The majority (59%) were male. The median injury severity score (ISS) was 10 (IQR:5-19). African Americans were disproportionally affected (27% vs 17% of all traumas), and the majority had public or no insurance (85%). Incidence was highest in the midwest and lowest in the northeast regions of the country, although trends varied over time. NAT resulted in 43% of trauma deaths in children <1 year and 31% of trauma deaths in children <5. Traumatic brain injury (TBI) was the most commonly encountered diagnosis (50%). Polytrauma was common, and certain injury patterns were identified. Urgent operation was required in 6%, 43% were admitted to intensive care, and 9% died. Mortality was independently associated with TBI, thoracic injury, hollow viscus injury and older age. |
4 |
| 112. Forbes-Amrhein MM, Dillman JR, Trout AT, et al. Frequency and Severity of Acute Allergic-Like Reactions to Intravenously Administered Gadolinium-Based Contrast Media in Children. Invest Radiol 2018;53:313-18. |
Review/Other-Dx |
32,365 administrations of GBCM |
To determine the frequency and severity of acute allergic-like reactions to gadolinium-based contrast media (GBCM) in children before, during, and after the transition from gadopentetate dimeglumine to gadoterate meglumine as our primary clinical GBCM. |
A total of 32,365 administrations of GBCM occurred during the study period (327 for gadofosveset trisodium; 672 for gadoxetate disodium; 12,012 for gadoterate meglumine; and 19,354 for gadopentetate dimeglumine). Allergic-like reactions occurred after 21 (0.06%) administrations. Reaction frequencies were not significantly different among the GBCM (0.3% gadofosveset trisodium; 0% gadoxetate disodium, 0.06% gadoterate meglumine, 0.08% gadopentetate dimeglumine; P > 0.05). Ten (47.6%) reactions were mild, 10 (47.6%) were moderate, and 1 (4.8%) was severe. The overall reaction frequency peaked during the 6-month transition period from gadopentetate dimeglumine to gadoterate meglumine (0.20%), compared with 0.07% pretransition (P = 0.048) and 0.04% posttransition (P = 0.0095). |
4 |
| 113. Henry MK, Bennett CE, Wood JN, Servaes S. Evaluation of the abdomen in the setting of suspected child abuse. Pediatr Radiol 2021;51:1044-50. |
Review/Other-Dx |
N/A |
To describe the clinical, laboratory and imaging evaluation of the abdomen in the setting of suspected child abuse. |
No results stated in the abstract. |
4 |
| 114. Section on Radiology. American Academy of Pediatrics. Diagnostic imaging of child abuse. Pediatrics 2009;123:1430-5. |
Review/Other-Dx |
N/A |
Review role of diagnostic imaging in cases of child abuse. |
Imaging helps to identify the extent of physical injury when abuse is present and clarifies all imaging findings that point to alternative diagnoses. High-quality technologies, clinical and pathologic alterations that occur in abused children are all important factors in diagnosis. |
4 |
| 115. Morad Y, Avni I, Benton SA, et al. Normal computerized tomography of brain in children with shaken baby syndrome. J AAPOS 2004;8:445-50. |
Review/Other-Dx |
9 cases |
To characterize the clinical presentation and clinical course of shaken baby syndrome (SBS) with normal cranial computerized tomography (CT) on admission and to suggest further diagnostic procedures in such circumstances. |
Nine cases were identified. While all children had an abnormal neurologic examination on admission, eight had a normal CT, and one had "widening of cranial sutures." In four cases, subdural hemorrhage was diagnosed on magnetic resonance imaging (MRI) 3 to 7 days after admission. Five children had bone fractures. The neurological outcome was normal in four of nine cases. Five children had long-term neurologic damage. The diagnosis of SBS was supported by either perpetrator confession, characteristic evolution of brain abnormalities on CT or MRI, inconsistent or absent explanatory history, and/or other social risk factors. |
4 |
| 116. Anilkumar A, Fender LJ, Broderick NJ, Somers JM, Halliday KE. The role of the follow-up chest radiograph in suspected non-accidental injury. Pediatr Radiol 2006;36:216-8. |
Review/Other-Dx |
200 children |
To evaluate the value of the follow-up chest radiograph in suspected non-accidental injury. |
Of 200 children included in the study, 59 (29.5%) reattended for a follow-up chest radiograph. The follow-up film provided useful additional information in 7 (12%) of the 59 children. In two children rib fractures were noted only on the follow-up chest radiograph. In a further two patients additional rib fractures were noted. Additional dating information was obtained for two patients. For one child both additional fractures and dating information were noted. |
4 |
| 117. Harper NS, Eddleman S, Lindberg DM. The utility of follow-up skeletal surveys in child abuse. Pediatrics. 2013;131(3):e672-678. |
Observational-Dx |
796 children |
To determine the proportion of FUSS that identified new information in a large, multicenter population of children with concerns of physical abuse. |
Among 2890 children enrolled in the Examining Siblings To Recognize Abuse research network, 2049 underwent skeletal survey and 796 (38.8%) had FUSS. A total of 174 (21.5%) subjects had new information identified by FUSS, including 124 (15.6%) with at least 1 new fracture and 55 (6.9%) with reassuring findings compared with the initial skeletal survey. Among cases with new fractures, the estimated likelihood of abuse increased in 41 (33%) cases, and 51 cases (41%) remained at the maximum likelihood of abuse. |
4 |
| 118. Harper NS, Lewis T, Eddleman S, Lindberg DM, ExSTRA Investigators. Follow-up skeletal survey use by child abuse pediatricians. Child Abuse & Neglect. 51:336-42, 2016 Jan. |
Review/Other-Dx |
2049 participants |
To determine variability between sites in rates of FUSS recommendation, completion and fracture identification among the 2,049 participants who had an initial skeletal survey. |
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. |
4 |
| 119. Bennett BL, Chua MS, Care M, Kachelmeyer A, Mahabee-Gittens M. Retrospective review to determine the utility of follow-up skeletal surveys in child abuse evaluations when the initial skeletal survey is normal. BMC Res Notes. 2011;4:354. |
Observational-Dx |
47 children |
To evaluate the utility of a follow-up skeletal survey in suspected child physical abuse evaluations when the initial skeletal survey is normal. |
Forty-seven children had a negative initial skeletal survey and were included for analysis. The mean age was 6.9 months (SD 5.7); the mean number of days between skeletal surveys was 18.7 (SD 10.1)Four children (8.5%) had signs of healing bone trauma on a follow-up skeletal survey. Three of these children (75%) had healing rib fractures and one child had a healing proximal humerus fracture. The findings on the follow-up skeletal survey yielded forensically important information in all 4 cases and strengthened the diagnosis of non-accidental trauma. |
3 |
| 120. Zimmerman S, Makoroff K, Care M, Thomas A, Shapiro R. Utility of follow-up skeletal surveys in suspected child physical abuse evaluations. Child Abuse Negl 2005; 29(10):1075-1083.. |
Observational-Dx |
48 children |
Prospective study to evaluate the value of a follow-up skeletal survey in suspected child physical abuse evaluations. |
Follow-up skeletal survey yielded additional information in 22/48 patients (46%). It identified additional fractures or clarified tentative findings in children who were suspected victims of physical child abuse. The follow-up skeletal survey is recommended. |
4 |
| 121. Hansen KK, Keeshin BR, Flaherty E, et al. Sensitivity of the limited view follow-up skeletal survey. Pediatrics. 2014;134(2):242-248. |
Observational-Dx |
534 study subjects |
To determine if a large multicenter study would support the results of our previous single-center study. Our hypothesis was that there would be no clinically significant difference in results from a limited view SS2 protocol that omits the spine and pelvis views (when no spine or pelvis fractures or questioned fractures are present on SS1) compared with a traditional SS2 protocol for radiographic evaluation of suspected physical abuse. |
We identified 534 study subjects. Five subjects had newly identified spine fractures, and no subjects had newly identified pelvis fractures on traditional SS2 studies. Only 1 subject with a newly identified spine fracture would have been missed with the limited view SS2 protocol used in this study (0.2% [95% confidence interval: <0.005-1.0]). None of the newly identified fractures changed the abuse-related diagnosis. |
4 |
| 122. Sonik A, Stein-Wexler R, Rogers KK, Coulter KP, Wootton-Gorges SL. Follow-up skeletal surveys for suspected non-accidental trauma: can a more limited survey be performed without compromising diagnostic information? Child Abuse Negl. 2010;34(10):804-806. |
Observational-Dx |
22 cases |
To evaluate if certain radiographs can be excluded at follow-up skeletal survey without compromising the clinical efficacy. |
A total of 36 fractures were found on the initial bone survey in 16/22 patients (73%). Six patients had no fractures detected at initial survey. Follow-up bone surveys demonstrated an additional 3 fractures (2 extremities and 1 rib) in 3/22 cases (14%); 1 was in a patient whose initial survey was negative. No additional fractures in the skull, spine, pelvis, feet, or hands were detected in any case. In combination with patients reported in the literature (194 patients total) no new fracture of the skull, spine, pelvis, or hands was detected at follow-up survey. The skull, spine and pelvis radiographs are the highest dose-exposure studies of the skeletal survey. |
3 |
| 123. Navarro O, Babyn PS, Pearl RH. The value of routine follow-up imaging in pediatric blunt liver trauma. Pediatr Radiol 2000;30:546-50. |
Review/Other-Dx |
66 children |
To evaluate the utility of routine follow-up computed tomography (CT) and/or ultrasound (US) scans in children with blunt hepatic trauma initially managed non-operatively. |
Of the 66 children, 30 were not followed with any imaging study, 26 were followed with US only, 7 with CT only and 3 with US and CT. Disappearance of the liver lesion(s) was seen in 25 patients (range: 6 days - 14 months) and decrease in size was noted in 10. In one patient, who developed abdominal and right shoulder pain 10 days after presentation with subsequent hemoglobin drop, CT showed contrast medium extravasation into a hepatic hematoma from portal vein injury that required surgery. |
4 |
| 124. Baldwin JA, Oliver JE. Epidemiology and family characteristics of severely-abused children. Br J Prev Soc Med 1975;29:205-21. |
Review/Other-Dx |
N/A |
To report on epidemiology and family characteristics of severely-abused children. |
No results stated in abstract. |
4 |
| 125. Hamilton-Giachritsis CE, Browne KD. A retrospective study of risk to siblings in abusing families. J Fam Psychol 2005;19:619-24. |
Review/Other-Dx |
795 siblings |
To describe the risk of siblings in abusing families. |
The sample in the present study consisted of the 795 siblings from a cohort of 400 "index" children who had been referred to police child protection units in England for abuse and/or neglect. In 44% of families (valid cases), the index child was scapegoated, in 37% maltreatment was nonspecific to all siblings, and in 20% maltreatment was specifically directed at some but not all siblings. Scapegoated children were more likely to be older and to experience physical or sexual abuse, whereas younger children and index child referrals for neglect, emotional abuse, or mixed abuse were associated with risk to some or all siblings. Parental difficulties and family stressors increased the risk of maltreatment to all siblings. There was no evidence of increased risk to stepsiblings or children with difficulties, suggesting that the special victim model has limited application. |
4 |
| 126. Mankad K, Sidpra J, Mirsky DM, et al. International Consensus Statement on the Radiological Screening of Contact Children in the Context of Suspected Child Physical Abuse. JAMA Pediatr 2023;177:526-33. |
Review/Other-Dx |
N/A |
To report an evidence-based and consensus-derived set of best practices for the radiological screening of contact children in the context of suspected child physical abuse. |
Contacts are defined as the asymptomatic siblings, cohabiting children, or children under the same care as an index child with suspected child physical abuse. All contact children should undergo a thorough physical examination and a history elicited prior to imaging. Contact children younger than 12 months should have neuroimaging, the preferred modality for which is magnetic resonance imaging, and skeletal survey. Contact children aged 12 to 24 months should undergo skeletal survey. No routine imaging is indicated in asymptomatic children older than 24 months. Follow-up skeletal survey with limited views should be performed if abnormal or equivocal at presentation. Contacts with positive findings should be investigated as an index child. |
4 |
| 127. Wei SC, Ulmer S, Lev MH, Pomerantz SR, Gonzalez RG, Henson JW. Value of coronal reformations in the CT evaluation of acute head trauma. AJNR. 2010;31(2):334-339. |
Observational-Dx |
213 patients |
Prospective study to evaluate whether coronal reformations improve detection of intracranial hemorrhage in noncontrast cranial CT performed for head trauma. |
Of 213 patients, 32 noncontrast cranial CT demonstrated intracranial hemorrhage (a total of 104 foci). 15/104 (14%) intracranial hemorrhages (8 patients) were detected solely on coronal images. Locations included the floor of the anterior and middle cranial fossas, vertex, corpus callosum, falx, tentorium, and occipital convexity. Coronal reformations allowed exclusion of suspicious findings on axial images in 14 instances (7 patients). Coronal images aided interpretation in 29/104 (28%) findings. Coronal reformations improve the detection of intracranial hemorrhage over axial images alone, especially for lesions that lie in the axial plane immediately adjacent to bony surfaces. The use of coronal reformations should be considered in the routine interpretation of head CT examinations performed for the evaluation of head trauma. |
3 |
| 128. Zacharia TT, Nguyen DT. Subtle pathology detection with multidetector row coronal and sagittal CT reformations in acute head trauma. Emerg Radiol. 2010;17(2):97-102. |
Observational-Dx |
200 patients |
To retrospectively analyze the advantages of coronal and sagittal reformations obtained with MDCT in patients with acute head trauma. Images analyzed by two independent, blinded readers. |
CT imaging abnormalities were detected in 55/200 patients who were scanned for head trauma. Acute traumatic intracranial abnormality was detected on axial scans in 45 patients. Subtle findings were confirmed on coronal and sagittal CT reformations in 10 cases, and these were undetected initially on axial CT. Coronal and sagittal reformations confirmed subtle findings in 18.2% (10/55) of the cases (P=0.001). Indeterminate neuroimaging findings confirmed by coronal and sagittal CT head reformations include tentorial and interhemispheric fissure subdural hemorrhage, subarachnoid hemorrhage, and inferior frontal and temporal lobe contusions. Overall, coronal and sagittal reformations improved diagnostic confidence and interobserver agreement over axial images alone for visualization of normal structures and in the diagnosis of acute abnormality. |
2 |
| 129. Halstead S, Scott G, Thust S, Hann G. Review of the new RCR guidelines (2017): The radiological investigation of suspected physical abuse in children. Arch Dis Child Educ Pract Ed 2019;104:309-12. |
Review/Other-Dx |
N/A |
To summarise the latest Royal College of Radiology guidance published in September 2017. |
No abstract available. |
4 |
| 130. Witte S, Fegert JM, Walper S. Risk of maltreatment for siblings: Factors associated with similar and different childhood experiences in a dyadic sample of adult siblings. Child Abuse Negl 2018;76:321-33. |
Review/Other-Dx |
870 pairs of siblings |
To describe the factors associated with the risk of maltreatment of siblings |
No results stated in abstract. |
4 |
| 131. Measuring Sex, Gender Identity, and Sexual Orientation. |
Review/Other-Dx |
N/A |
Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. |
No abstract available. |
4 |
| 132. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
