Belfer R A, Klein B L, Orr L
Department of Emergency Medicine, Cooper Hospital/University Medical Center, UMDNJ-Robert Wood Johnson Medical School at Camden, Camden, NJ, USA.
Am J Emerg Med. 2001 Mar;19(2):122-4. doi: 10.1053/ajem.2001.21345.
The radiologic skeletal survey is an important tool for evaluating occult trauma in suspected child abuse. The purposes of this study were: (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. We retrospectively reviewed the medical records of 203 children admitted over a 30-month period to Children's National Medical Center for alleged physical abuse. Skeletal surveys were ordered based on the treating physicians' clinical suspicions. Patients in whom skeletal surveys were positive for an occult fracture were studied in more detail. 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.
放射学骨骼检查是评估疑似虐待儿童中隐匿性创伤的重要工具。本研究的目的是：（1）确定通过骨骼检查发现的临床未怀疑骨折的发生率，以及（2）识别将从骨骼检查中受益的高危儿童群体。我们回顾性地审查了在30个月期间因涉嫌身体虐待而入住儿童国家医疗中心的203名儿童的病历。根据主治医生的临床怀疑开出骨骼检查的医嘱。对骨骼检查发现隐匿性骨折呈阳性的患者进行了更详细的研究。共进行了96次骨骼检查；其中，25次至少有1处临床未怀疑骨折呈阳性。80%的隐匿性骨折见于1岁以下儿童。出现新骨折或颅内损伤会使儿童发生隐匿性骨折的风险更高。相比之下，烧伤患者隐匿性骨折的检出率非常低。患者的年龄和可疑损伤类型可帮助医生指导何时进行骨骼检查。
