Barber Ignasi, Perez-Rossello Jeannette M, Wilson Celeste R, Kleinman Paul K
Pediatric Radiology Department, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Av Vall d'Hebron, 119-129, Barcelona, Spain,
Pediatr Radiol. 2015 Jan;45(1):69-80. doi: 10.1007/s00247-014-3064-3. Epub 2014 Jul 6.
Skeletal surveys are routinely performed in cases of suspected child abuse, but there are limited data regarding the yield of high-detail skeletal surveys in infants.
To determine the diagnostic yield of high-detail radiographic skeletal surveys in suspected infant abuse.
We reviewed the high-detail American College of Radiology standardized skeletal surveys performed for suspected abuse in 567 infants (median: 4.4 months, SD 3.47; range: 4 days-12 months) at a large urban children's hospital between 2005 and 2013. Skeletal survey images, radiology reports and medical records were reviewed. A skeletal survey was considered positive when it showed at least one unsuspected fracture.
In 313 of 567 infants (55%), 1,029 definite fractures were found. Twenty-one percent (119/567) of the patients had a positive skeletal survey with a total of 789 (77%) unsuspected fractures. Long-bone fractures were the most common injuries, present in 145 children (26%). The skull was the site of fracture in 138 infants (24%); rib cage in 77 (14%), clavicle in 24 (4.2%) and uncommon fractures (including spine, scapula, hands and feet and pelvis) were noted in 26 infants (4.6%). Of the 425 infants with neuroimaging, 154 (36%) had intracranial injury. No significant correlation between positive skeletal survey and associated intracranial injury was found. Scapular fractures and complex skull fractures showed a statistically significant correlation with intracranial injury (P = 0.029, P = 0.007, respectively).
Previously unsuspected fractures are noted on skeletal surveys in 20% of cases of suspected infant abuse. These data may be helpful in the design and optimization of global skeletal imaging in this vulnerable population.
对于疑似虐待儿童的病例，通常会进行骨骼检查，但关于婴儿高细节骨骼检查的检出率的数据有限。
确定高细节X线骨骼检查在疑似婴儿虐待中的诊断检出率。
我们回顾了2005年至2013年间在一家大型城市儿童医院对567名疑似受虐婴儿（中位数：4.4个月，标准差3.47；范围：4天至12个月）进行的高细节美国放射学会标准化骨骼检查。对骨骼检查图像、放射学报告和病历进行了回顾。当骨骼检查显示至少一处意外骨折时，则认为该检查为阳性。
在567名婴儿中的313名（55%）发现了1029处明确骨折。21%（119/567）的患者骨骼检查呈阳性，共有789处（77%）意外骨折。长骨骨折是最常见的损伤，见于145名儿童（26%）。138名婴儿（24%）的骨折部位在颅骨；77名（14%）在胸廓，24名（4.2%）在锁骨，26名婴儿（4.6%）有不常见骨折（包括脊柱、肩胛骨、手和脚以及骨盆）。在425名进行神经影像学检查的婴儿中，154名（36%）有颅内损伤。未发现骨骼检查阳性与相关颅内损伤之间存在显著相关性。肩胛骨骨折和复杂颅骨骨折与颅内损伤在统计学上有显著相关性（分别为P = 0.029，P = 0.007）。
在20%的疑似婴儿虐待病例中，骨骼检查发现了之前未被怀疑的骨折。这些数据可能有助于设计和优化针对这一弱势群体的全球骨骼成像。
