1 Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Dr, Rm 1053, Indianapolis, IN, 46202.
AJR Am J Roentgenol. 2014 Apr;202(4):868-71. doi: 10.2214/AJR.13.11068.
The purpose of our study was to determine whether adding oblique bilateral rib radiography to the skeletal survey for child abuse significantly increases detection of the number of rib fractures.
We identified all patients under 2 years old who underwent a skeletal survey for suspected child abuse from January 2003 through July 2011 and who had at least one rib fracture. These patients were age-matched with control subjects without fractures. Two randomized radiographic series of the ribs were performed, one containing two views (anteroposterior and lateral) and another with four views (added right and left oblique). Three fellowship-trained radiologists (two in pediatrics and one in trauma) blinded to original reports independently evaluated the series using a Likert scale of 1 (no fracture) to 5 (definite fracture). We analyzed the following: sensitivity and specificity of the two-view series for detection of any rib fracture and for location (using the four-view series as the reference standard), interobserver variability, and confidence level.
We identified 212 patients (106 with one or more fractures and 106 without). The sensitivity and specificity of the two-view series were 81% and 91%, respectively. Sensitivity and specificity for detection of posterior rib fractures were 74% and 92%, respectively. There was good agreement between observers for detection of rib fractures in both series (average kappa values of 0.70 and 0.78 for two-views and four-views, respectively). Confidence significantly increased for four-views.
Adding bilateral oblique rib radiographs to the skeletal survey results in increased rib fracture detection and increased confidence of readers.
我们研究的目的是确定在儿童虐待骨骼检查中增加斜位双侧肋骨 X 光检查是否能显著提高肋骨骨折数量的检出率。
我们从 2003 年 1 月至 2011 年 7 月确定了所有因疑似儿童虐待而接受骨骼检查且至少有一处肋骨骨折的 2 岁以下患者。这些患者与无骨折的对照组按年龄匹配。进行了两组随机的肋骨 X 光检查，一组包括两个视图（前后位和侧位），另一组增加了右和左侧斜位。三位接受过 fellowship 培训的放射科医生（两位儿科医生和一位创伤科医生）对原始报告不知情，使用 1（无骨折）至 5（明确骨折）的李克特量表独立评估了这两组 X 光检查结果。我们分析了以下内容：两视图系列检测任何肋骨骨折和定位（使用四视图系列作为参考标准）的敏感性和特异性、观察者间的变异性以及置信水平。
我们确定了 212 名患者（106 名有一处或多处骨折，106 名无骨折）。两视图系列的敏感性和特异性分别为 81%和 91%。检测后肋骨折的敏感性和特异性分别为 74%和 92%。在两系列 X 光检查中，观察者之间对肋骨骨折的检测均有良好的一致性（两视图和四视图的平均kappa 值分别为 0.70 和 0.78）。四视图检查的置信度显著提高。
在骨骼检查中增加双侧斜位肋骨 X 光检查可提高肋骨骨折的检出率并增加读者的信心。
