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Examining the Role of Follow-Up Skeletal Surveys in Non-Accidental Trauma
Rebecca D. Powell, PhD, Nora E. Raynor, RN,MSN, Donna A. Goodenow, BS, David G. Jacobs, MD, and Anthony Stallion, MD, Carolinas Medical Center, Charlotte NC

Abstract:
Introduction: Non-accidental trauma (NAT) represents a significant cause of morbidity in children. Diagnosing NAT can be challenging and often includes a series of radiographs, known as a skeletal survey, to identify bony abnormalities indicative of abuse. At our hospital, a follow-up survey is typically repeated in two weeks to assess for injuries previously unseen. We examined whether the extensive nature of this imaging is necessary and whether follow-up surveys are warranted. Methods: We queried our trauma database to identify cases of suspected NAT in children less than 3 years old (2013-2014). Initial and follow-up skeletal findings, injury type and radiation exposure were examined. Results: Of 110 patients, 91 (83%) had positive initial findings. In follow-up surveys, 20% had new injuries identified in the first year of study compared to only 6% in the second. In patients with negative initial imaging, no new injuries were revealed on follow-up. Characterizing by injury demonstrated the skull, femur and ribs to be the most prevalent types of injury. No patients had pelvic injuries, while spinal injuries accounted for approximately 1% of cases. Conversely, pelvic images result in the greatest radiation exposure (70mrem), followed by lumbar and c-spine films (30 and 27mrem). Conclusions: These findings suggest that routine follow-up skeletal surveys are unnecessary with negative initial imaging. Furthermore, as pelvic and spinal injuries are uncommon, the radiation exposure to these areas may warrant their exclusion from initial skeletal surveys unless clinical examination indicates otherwise.Objective:
At the end of this presentation, the learner will be able to discuss the role of follow-up skeletal surveys in non-accidental trauma and how that role may need modification.


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