Skeletal survey yields in low vs. high risk pediatric patients with skull fractures,Child Abuse & Neglect

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Skeletal survey yields in low vs. high risk pediatric patients with skull fractures
Child Abuse & Neglect ( IF 4.863 ) Pub Date : 2023-03-09 , DOI: 10.1016/j.chiabu.2023.106130
Reena Isaac ₁ , Christopher Greeley ₁ , Mark Marinello ₂ , Bruce E Herman ₃ , Terra N Frazier ₄ , Christopher L Carroll ₅ , Veronica Armijo-Garcia ₆ , Matthew Musick ₁ , Kerri Weeks ₇ , Suzanne B Haney ₈ , Ming Wang ₉ , Kent P Hymel ₁₀ ,

Affiliation

Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St., Houston, TX 77030, USA.
Department of Pediatrics, Children's Hospital of Richmond at VCU, 1250 East Marshall Street, Richmond, VA 23219, USA.
Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, UT 84113, USA.
Department of Pediatrics, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
Department of Pediatrics, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA.
University of Texas Health Sciences Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
Department of Pediatrics, University of Kansas School of Medicine, 3243 East Murdoch, Wichita, KS 67208, USA.
Department of Pediatrics, University of Nebraska Medical Center, Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA.
Department of Public Health Sciences, Penn State College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, USA.
Department of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, 600 University Drive, Hershey, PA 17033, USA.

Background

To assess for occult fractures, physicians often opt to obtain skeletal surveys (SS) in young, acutely head-injured patients who present with skull fractures. Data informing optimal decision management are lacking.

Objective

To determine the positive yields of radiologic SS in young patients with skull fractures presumed to be at low vs. high risk for abuse.

Participants and setting

476 acutely head injured, skull-fractured patients <3 years hospitalized for intensive care across 18 sites between February 2011 and March 2021.

Methods

We conducted a retrospective, secondary analysis of the combined, prospective Pediatric Brain Injury Research Network (PediBIRN) data set.

Results

204 (43 %) of 476 patients had simple, linear, parietal skull fractures. 272 (57 %) had more complex skull fracture(s). Only 315 (66 %) of 476 patients underwent SS, including 102 (32 %) patients presumed to be at low risk for abuse (patients who presented with a consistent history of accidental trauma; intracranial injuries no deeper than the cortical brain; and no respiratory compromise, alteration or loss of consciousness, seizures, or skin injuries suspicious for abuse). Only one of 102 low risk patients revealed findings indicative of abuse. In two other low risk patients, SS helped to confirm metabolic bone disease.

Conclusions

Less than 1 % of low risk patients under three years of age who presented with simple or complex skull fracture(s) revealed other abusive fractures. Our results could inform efforts to reduce unnecessary skeletal surveys.

中文翻译：

低风险与高风险儿童颅骨骨折患者的骨骼调查结果

背景

为了评估隐匿性骨折，医生通常选择对出现颅骨骨折的年轻、急性头部受伤患者进行骨骼检查 (SS)。缺乏告知最佳决策管理的数据。

客观的

确定被认为处于低滥用风险与高滥用风险的年轻颅骨骨折患者的放射学 SS 的阳性率。

参与者和设置

2011 年 2 月至 2021 年 3 月期间，在 18 个地点住院接受重症监护的 476 名急性头部受伤、颅骨骨折患者 <3 年。

方法

我们对组合的前瞻性儿科脑损伤研究网络 (PediBIRN) 数据集进行了回顾性二次分析。

结果

476 名患者中有 204 名 (43%) 患有简单的线性顶骨骨折。272 人 (57 %) 有更复杂的颅骨骨折。476 名患者中只有 315 名 (66%) 接受了 SS，包括 102 名 (32%) 被认为处于低虐待风险的患者（具有一致的意外创伤史的患者；颅内损伤不深于皮质脑；并且没有呼吸系统受损、意识改变或丧失、癫痫发作或疑似滥用的皮肤损伤）。102 名低风险患者中只有一名透露了表明虐待的发现。在另外两名低风险患者中，SS 帮助确认了代谢性骨病。