Blangis Flora, Poullaouec Cyrielle, Launay Elise, Vabres Nathalie, Sadones Flavie, Eugène Thomas, Cohen Jérémie F, Chalumeau Martin, Gras-Le Guen Christèle
Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, Paris, France.
INSERM CIC 1413, Nantes University Hospital, Nantes, France.
Front Pediatr. 2020 Sep 25;8:498. doi: 10.3389/fped.2020.00498. eCollection 2020.
Timely diagnosis of child physical abuse is of paramount importance. The added value of bone scintigraphy (BS) after a negative radiological skeletal survey (RSS) in children with suspected physical abuse has never been evaluated. The objective of this study was to assess the extent to which BS could improve the detection rate of skeletal injury in children with suspected physical abuse with an initial negative RSS. We used discharge codes to retrospectively identify children evaluated for suspected physical abuse in a university hospital (Nantes, France). We included all consecutive children younger than 3 years old who underwent both RSS and BS, with an interval of ≤96 h between tests, from 2013 to 2019. BS and RSS results were interpreted independently during the study period. We specifically analyzed BS results for children with a negative RSS to assess the value of BS as an add-on test. Among the 268 children ≤3 years old with suspected physical abuse who underwent RSS, 140 (52%) also underwent BS within 96 h and were included in the analysis. The median age was 6 months old (interquartile range: 3-8). The detection rate of ≥1 skeletal injury with RSS alone was 49% ( = 69/140, 95% CI: 41-58%) vs. 58% ( = 81/140, 50-66%) with RSS followed by add-on BS, for an absolute increase in the detection rate of 9% points (95% CI: 4-14%). The number of children with a negative RSS who would need to undergo BS to detect one additional child with ≥1 skeletal injury was 6 (95% CI: 4-11). In young children with suspected physical abuse with a negative RSS, add-on BS would allow for a clinically significant improvement in the detection rate of skeletal injuries for a limited number of BS procedures required. Prospective multicenter studies are needed to confirm these findings.
及时诊断儿童身体虐待至关重要。对于疑似身体虐待的儿童，在放射学骨骼检查（RSS）结果为阴性后，骨闪烁显像（BS）的附加价值从未得到评估。本研究的目的是评估BS在初始RSS为阴性的疑似身体虐待儿童中能在多大程度上提高骨骼损伤的检出率。我们使用出院编码回顾性地识别在一家大学医院（法国南特）接受疑似身体虐待评估的儿童。我们纳入了2013年至2019年期间所有连续接受RSS和BS检查、两次检查间隔≤96小时的3岁以下儿童。在研究期间，BS和RSS结果由不同人员独立解读。我们专门分析了RSS结果为阴性的儿童的BS结果，以评估BS作为附加检查的价值。在268名接受RSS检查的3岁及以下疑似身体虐待儿童中，140名（52%）在96小时内也接受了BS检查并纳入分析。中位年龄为6个月（四分位间距：3 - 8个月）。仅RSS检查时≥1处骨骼损伤的检出率为49%（n = 69/140，95%置信区间：41 - 58%），而RSS后加做BS检查时为58%（n = 81/140，50 - 66%），检出率绝对提高了9个百分点（95%置信区间：4 - 14%）。RSS结果为阴性的儿童中，需要接受BS检查才能多检出1例有≥1处骨骼损伤儿童的数量为6例（95%置信区间：4 - 11例）。对于RSS结果为阴性的疑似身体虐待幼儿，加做BS检查只需进行有限数量的BS检查程序，就能在临床上显著提高骨骼损伤的检出率。需要进行前瞻性多中心研究来证实这些发现。
