TY - JOUR
T1 - Follow-up skeletal survey use by child abuse pediatricians
AU - for the ExSTRA investigators
AU - Harper, Nancy S.
AU - Lewis, Terri
AU - Eddleman, Sonja
AU - Lindberg, Daniel M.
AU - Coffman, Jayme
AU - Bretl, Deb
AU - Deye, Katherine
AU - Laskey, Antoinette L.
AU - Harris, Tara
AU - Duralde, Yolanda
AU - Donaruma-Kwoh, Marcella
AU - Steiner, Daryl
AU - Feldman, Ken
AU - Schwartz, Kimberly
AU - Shapiro, Robert A.
AU - Greiner, Mary
AU - Newton, Alice
AU - Berger, Rachel
AU - Kim, Ivone
AU - Hymel, Kent
AU - Haney, Suzanne
AU - Pekarsky, Alicia
AU - Asnes, Andrea
AU - McPherson, Paul
AU - Mehta, Neha
AU - Gladstone, Gwendolyn
N1 - Publisher Copyright:
© 2015 Elsevier Ltd.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Skeletal survey is frequently used to identify occult fractures in young children with concern for physical abuse. Because skeletal survey is relatively insensitive for some abusive fractures, a follow-up skeletal survey (FUSS) may be undertaken at least 10-14 days after the initial skeletal survey to improve sensitivity for healing fractures. This was a prospectively planned secondary analysis of a prospective, observational study of 2,890 children who underwent subspecialty evaluation for suspected child physical abuse at 1 of 19 centers. Our objective was to determine variability between sites in rates of FUSS recommendation, completion and fracture identification among the 2,049 participants who had an initial SS. Among children with an initial skeletal survey, the rate of FUSS recommendation for sites ranged from 20% to 97%; the rate of FUSS completion ranged from 10% to 100%. Among sites completing at least 10 FUSS, rates of new fracture identification ranged from 8% to 28%. Among completed FUSS, new fractures were more likely to be identified in younger children, children with higher initial level of concern for abuse, and those with a fracture or cutaneous injury identified in the initial evaluation. The current variability in FUSS utilization is not explained by variability in occult fracture prevalence. Specific guidelines for FUSS utilization are needed.
AB - Skeletal survey is frequently used to identify occult fractures in young children with concern for physical abuse. Because skeletal survey is relatively insensitive for some abusive fractures, a follow-up skeletal survey (FUSS) may be undertaken at least 10-14 days after the initial skeletal survey to improve sensitivity for healing fractures. This was a prospectively planned secondary analysis of a prospective, observational study of 2,890 children who underwent subspecialty evaluation for suspected child physical abuse at 1 of 19 centers. Our objective was to determine variability between sites in rates of FUSS recommendation, completion and fracture identification among the 2,049 participants who had an initial SS. Among children with an initial skeletal survey, the rate of FUSS recommendation for sites ranged from 20% to 97%; the rate of FUSS completion ranged from 10% to 100%. Among sites completing at least 10 FUSS, rates of new fracture identification ranged from 8% to 28%. Among completed FUSS, new fractures were more likely to be identified in younger children, children with higher initial level of concern for abuse, and those with a fracture or cutaneous injury identified in the initial evaluation. The current variability in FUSS utilization is not explained by variability in occult fracture prevalence. Specific guidelines for FUSS utilization are needed.
KW - Follow-up skeletal survey
KW - Fracture
KW - Physical abuse
KW - Variability
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U2 - 10.1016/j.chiabu.2015.08.015
DO - 10.1016/j.chiabu.2015.08.015
M3 - Article
C2 - 26342432
AN - SCOPUS:84952864513
SN - 0145-2134
VL - 51
SP - 336
EP - 342
JO - Child Abuse and Neglect
JF - Child Abuse and Neglect
ER -