Lindberg Daniel M, Harper Nancy S, Laskey Antoinette L, Berger Rachel P
Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, USA.
Pediatr Emerg Care. 2013 Jan;29(1):26-9. doi: 10.1097/PEC.0b013e31827b475e.
Recently, it has been suggested that views of the hands, feet, spine, and pelvis should be omitted from routine skeletal surveys (SSs) because these fractures are rarely identified by SS. Our objective was to describe the prevalence of fractures to the hands, feet, spine, or pelvis among SSs obtained for children in a large, multicenter population who underwent consultation for physical abuse.
This was a retrospective secondary analysis of data from the Examining Siblings To Recognize Abuse research network, a consortium of 20 U.S. child abuse teams who collected data for all children younger than 10 years who underwent consultation for concerns of physical abuse. This secondary analysis included data only from index children and excluded data from siblings and contacts. Consulting child abuse physicians reported the number of fractures identified and those that were detected by SS.
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.
A significant number of occult, abusive fractures would have been missed if SSs had omitted or deferred views of the hands, feet, spine, and pelvis. Given the risks associated with missed abuse, these views should be routinely included in the radiographic SS.
最近有人提出，手部、足部、脊柱和骨盆的X线片应从常规骨骼检查（SS）中省略，因为这些骨折在SS中很少被发现。我们的目的是描述在一个大型多中心人群中，因遭受身体虐待而接受咨询的儿童所进行的SS中，手部、足部、脊柱或骨盆骨折的患病率。
这是一项对“检查兄弟姐妹以识别虐待”研究网络数据的回顾性二次分析，该网络由20个美国儿童虐待问题小组组成，收集了所有因身体虐待问题接受咨询的10岁以下儿童的数据。这项二次分析仅包括索引儿童的数据，排除了兄弟姐妹和联系人的数据。咨询儿童虐待问题的医生报告了识别出的骨折数量以及SS检测到的骨折数量。
在2049份初始SS中，471份（23.0%）显示至少有1处先前未知的骨折，其中49份（10.4%）显示手部、足部、脊柱或骨盆骨折。在10例病例中，当未发现其他骨折时，SS识别出至少1处手部、足部、脊柱或骨盆骨折。
如果SS省略或推迟拍摄手部、足部、脊柱和骨盆的X线片，将会遗漏大量隐匿性虐待骨折。鉴于漏诊虐待相关的风险，这些部位的X线片应常规纳入影像学SS检查中。
