The use of the skeletal survey in suspected physical child abuse – a case report

Česká verzia

Authors: Peychl Ivan ¹; Vilkusová Lada ²; Mašková Ladislava ²; Popelová Eliška ³; Škvařil Jan ⁴; Pospíšilová Romana ⁵; Navrátilová Klára ¹; Vašíčková Jana ¹; Voráčková Theodora ¹; Mašek Martin ²
Authors place of work: Pediatrické oddělení, FN Bulovka, Praha ¹; Radiodiagnostické oddělení, FN Bulovka, Praha ²; Klinika zobrazovacích metod, 2. lékařská fakulta, Univerzita, Karlova a FN Motol, Praha ³; Oddělení dětské chirurgie, FN Bulovka, Praha ⁴; Dětská ordinace Pediatrie RP, s. r. o., Roudnice nad Labem ⁵
Published in the journal: Čes-slov Pediat 2024; 79 (3): 156-160.
Category: Case Report
doi: https://doi.org/10.55095/CSPediatrie2024/009

Summary

A six month old girl with limited left leg movement and left foot and left lower leg edema was admitted to the pediatric department. There was no history of trauma. Plain radiographs showed a left tibial fractures. Due to suspected abusive origin of the injury, the girl underwent a thorough examination, including a full initial and follow-up skeletal survey. Multiple fractures were detected, including a clinically occult right leg fracture. Healing of all injuries was uncomplicated and required conservative approach only. The case was referred to the police and Child Protection Services for further management.

Keywords:

fractures – child physical abuse – radiological skeletal survey – follow-up skeletal survey

Zdroje

Korespondenční adresa:

Ivan Peychl
Pediatrické oddělení FN Bulovka
Budínova 67/2
180 81 Praha 8
ivan.peychl@bulovka.cz

1. The World Health Organisation. Lifetime prevalence of physical abuse for children aged < 18 years (%). [online], Dostupné na: https: //www.who.int/data/gho/indicator-metadata-registry/imr-details/4466

2. Potter MH, Kennedy RS, Font SA. Rates and predictors of child maltreatment re-perpetration against new victims and prior victims. Child Abuse Negl 2022; 123(105419): 1–14.

3. Hymel KP, Makoroff KL, Laskey AL, et al. Mechanisms, clinical presentations, injuries and outcomes from inflicted versus noninflicted head trauma during infancy: results of a prospective, multicentred, comparative study. Pediatrics 2007; 119(5): 922–929.

4. Lansford JE, Godwin J, McMahon RJ, et al. Early physical abuse and adult outcomes. Pediatrics 2021; 147(1): e20200873.

5. Gilbert R, Widom CS, Browne K, et al. Burden and consequences of child maltreatment in high-income countries. Lancet 2009; 373: 68–81.

6. Christian CV; Committe on Child Abuse and Neglect. The evaluation of suspected child physical abuse. Pediatrics 2015; 135(5): e20150356.

7. Gilbert R, Kemp, et al. Recognising and responding to child maltreatment. Lancet 2009; 373: 167–180.

8. Sittig JS, Uiterwaal CSPM, Moons K, et al.Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study. BMJ Open 2016; 6(3): e010788.

9. The American College of Radiology, The Society for Pediatric Radiology. ACR-SPR practice parameter for the performance and interpretation of skeletal surveys in children. [online]. Dostupné na: https: //www.acr.org/-/media/ACR/Files/Practice-Parameters/skeletal-survey.pdf?la=en

10. The Royal College of Radiologists, The Society and College of Radiographers. The radiological investigation of suspected physical abuse in children. 2018. [online]. Dostupné na: https: //www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr174_suspected_physical_abuse.pdf

11. American Academy of Pediatrics, Section on Radiology. Diagnostic imaging of child abuse. Pediatrics 1991; 87(2): 262–264.

12. Kleinman PK, Blackbourne BD, et al. Radiologic contributions to the investigation and prosecution of cases of fatal infant abuse. NEJM 1989; 320: 507–11.

13. Popelová E, Kynčl M, Špeciánová Š. Postavme se na stranu dětí: Doporučení pro využití zobrazovacích metod při podezření na týrané dítě. [online]. Dostupné na: https: //www.pediatrics.cz/content/uploads/2021/08/doporuceni-ptd_e-verze_02.pdf

14. Ministerstvo zdravotnictví ČR. Národní radiologické standardy a indikační kritéria – skiagrafie dětí. 2022. [online]. Dostupné na: https: //www.mzcr.cz/wp-content/uploads/2022/11/Vestnik-MZ_14-2022.pdf

15. Ministerstvo zdravotnictví ČR. Metodické opatření. Postup praktických lékařů pro děti a dorost při podezření na týrané, zneužívané a zanedbávané dítě (syndrom CAN). 2022. [online]. Dostupné na: https: //www.mzcr.cz/metodicke-opatreni-postup-praktickych-lekaru-pro-deti-a-dorost-pri-podezreni-na-tyrane-zneuzivane-a-zanedbavane-dite-syndrom-can/.

16. Marine MB, Forbes-Amrhein MB. Fractures of child abuse. Pediatr Radiol 2021; 51(6): 1003–1013.

17. Rao R, Browne D, et al. Radiation doses in diagnostic imaging for suspected physical abuse. Arch Dis Child 2019; 104(9): 863–868.

18. Perez-Rosello JM, Conolly SA, et al. Whole-body MRI in suspected infant abuse. Am J Roentgenol 2010; 195(3): 744–750.

19. Benett BL, Chua MS, et al. Retrospective review to determine the utility of follow-up skeletal surveys in child abuse evaluations when the initial skeletal survey is normal. BMC Res Notes 2011; 4: 354.

20. Singh R, Squires J, et al. Assessing the use of follow-up skeletal surveys in children with suspected physical abuse. J Trauma Acute Care Surg 2012; 73(4): 972–976.