Day Fiona, Clegg Sarah, McPhillips Maeve, Mok Jacqueline
Department of Community Child Health, Royal Hospital for Sick Children, 10 Chalmers Crescent, Edinburgh EH9 1TS, Scotland.
J Clin Forensic Med. 2006 Feb;13(2):55-9. doi: 10.1016/j.jcfm.2005.08.001. Epub 2006 Feb 7.
The skeletal survey is widely used as the principal radiological investigation in suspected physical abuse of infants and young children. However, the evidence on which current guidelines are based is limited, especially for siblings of index cases. We conducted a retrospective study to describe the characteristics of children who underwent skeletal surveys for suspected non-accidental injury (NAI) in the Edinburgh area; to evaluate the diagnostic efficacy of skeletal surveys; and to identify any predictive factors that might guide clinical practice.
All skeletal surveys performed at the Royal Hospital for Sick Children in Edinburgh for suspected non-accidental injury between 1/1/99 and 31/12/03 were reviewed.
Seventy-seven children underwent skeletal surveys for suspected NAI. Data were available for 76 (70 index cases and 6 siblings). Of the index cases, 17 (24%) skeletal surveys were positive, with a mean of 2.5 fractures per child (range 0-9). The age of positive cases ranged from 2 weeks to 36 months with the majority (14, 82%) being under 12 months of age. Nine (53%) were boys. In index children with positive results, indications for skeletal survey were head injury (skull fracture in 2, 12%; intracranial injury in 4,24%); skeletal fracture (excluding skull fracture) in 6 (35%) and bruising in 4 (24%). chi(2) analysis revealed no significant differences in age, sex or primary reason for skeletal survey between those with a negative and positive skeletal survey. Six skeletal surveys were performed on siblings of children with known or suspected NAI. The siblings' ages ranged from 1 to 36 months although 3 (50%) were under 12 months of age. One (17%) of the siblings' surveys (a twin) was positive.
The age of a child (<12 months) and type of presenting injury (overt fracture or head injury) are factors which can help the clinician to decide whether or not to obtain a skeletal survey. There remains a lack of evidence for the effectiveness of skeletal survey in the siblings of index children. Guidelines for the process of repeating uncertain skeletal surveys are needed.
骨骼检查被广泛用作疑似婴幼儿身体虐待的主要放射学检查方法。然而，当前指南所依据的证据有限，尤其是对于索引病例的兄弟姐妹。我们进行了一项回顾性研究，以描述在爱丁堡地区因疑似非意外性损伤（NAI）接受骨骼检查的儿童的特征；评估骨骼检查的诊断效力；并确定可能指导临床实践的任何预测因素。
回顾了1999年1月1日至2003年12月31日期间在爱丁堡皇家儿童医院因疑似非意外性损伤而进行的所有骨骼检查。
77名儿童因疑似NAI接受了骨骼检查。76名儿童（70名索引病例和6名兄弟姐妹）的数据可用。在索引病例中，17例（24%）骨骼检查呈阳性，每名儿童平均有2.5处骨折（范围0 - 9处）。阳性病例的年龄范围为2周龄至36个月龄，大多数（14例，82%）在12个月龄以下。9例（53%）为男孩。在骨骼检查结果为阳性的索引儿童中，进行骨骼检查的指征为头部损伤（颅骨骨折2例，12%；颅内损伤4例，24%）；骨骼骨折（不包括颅骨骨折）6例（35%）和瘀伤4例（24%）。卡方分析显示，骨骼检查结果为阴性和阳性的儿童在年龄、性别或进行骨骼检查的主要原因方面无显著差异。对已知或疑似NAI儿童的兄弟姐妹进行了6次骨骼检查。兄弟姐妹的年龄范围为1至36个月龄，但3例（50%）在12个月龄以下。其中1例（17%）兄弟姐妹（一对双胞胎中的一个）的检查结果为阳性。
儿童年龄（<12个月）和损伤表现类型（明显骨折或头部损伤）是有助于临床医生决定是否进行骨骼检查的因素。对于索引儿童的兄弟姐妹，骨骼检查有效性的证据仍然不足。需要制定关于重复不确定骨骼检查过程的指南。
