Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024, 168(4):342-348 | DOI: 10.5507/bp.2023.018

Occult fractures detected on radiographs in young children with a concern for abusive head trauma

Eliska Popelova, Zuzana Holubova, Marcela Dvorakova, Martin Kyncl
Department of Radiology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic

Aims: To determine the incidence of children < 2 years old with suspected abusive head trauma, to evaluate usage of dedicated skeletal radiographs and the incidence of clinically occult fractures on dedicated skeletal radiographs.

Methods: This is a retrospective single centre study of children < 2 years old with traumatic brain injury, referred to the University Hospital's Social Services Department between December 31, 2012 and December 31, 2020. Clinical and demographic data was retrieved from medical notes and imaging was reviewed by paediatric radiologists.

Results: 26 children (17 males), 2 weeks to 21 months of age (median age 3 months) were included. Eleven children (42%) had traumatic history, fourteen children (54%) had one or more bruises, eighteen children (69%) had abnormal neurological findings. 16 children (62%) had dedicated skeletal radiographs, 7 children (27%) had radiographs of part of the skeleton and 3 children (11%) had no skeletal radiographs. 5 out of 16 children (31%) with dedicated skeletal radiographs had a clinically occult fracture. 15 (83%) of clinically occult fractures had high specificity for abuse.

Conclusion: The incidence of suspected abusive head trauma in children < 2 years old is low. Clinically occult fractures were detected in one third of children with dedicated skeletal radiographs. The majority of these fractures have high specificity for abuse. Dedicated skeletal imaging is not performed in more than one third of the children and hence fractures may be missed. Efforts should be taken to increase awareness of child abuse imaging protocols.

Keywords: children, abusive head trauma, non-accidental injury, abuse, imaging, fracture

Received: March 19, 2023; Revised: March 30, 2023; Accepted: May 3, 2023; Prepublished online: May 12, 2023; Published: November 22, 2024  Show citation

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Popelova, E., Holubova, Z., Dvorakova, M., & Kyncl, M. (2024). Occult fractures detected on radiographs in young children with a concern for abusive head trauma. Biomedical papers, 168(4), 342-348. doi: 10.5507/bp.2023.018
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    References

    1. Mulpuri K, Slobogean BL, Tredwell SJ. The epidemiology of nonaccidental trauma in children. Clin Orthop Relat Res 2011;469(3):759-67. Go to original source... Go to PubMed...
    2. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children Youth and Families, Children's Bureau. Child Maltreatment 2020. 2022 [cited 2023 Jan 18]. Available from: https://www.acf.hhs.gov/cb/data-research/child-maltreatment.
    3. Nuno M, Ugiliweneza B, Bardini RL, Ozturk A, Stephenson JT, Magana JN. Age-related mortality in abusive head trauma. J Trauma Acute Care Surg 2019;87(4):827-35. Go to original source... Go to PubMed...
    4. King WJ, MacKay M, Sirnick A. Shaken baby syndrome in Canada: clinical characteristics and outcomes of hospital cases. CMAJ 2003;168(2):155-9.
    5. Ewing-Cobbs L, Kramer L, Prasad M, Canales DN, Louis PT, Fletcher JM, Vollero H, Landry SH, Cheung K. Neuroimaging, physical, and developmental findings after inflicted and noninflicted traumatic brain injury in young children. Pediatrics 1998;102(2 Pt 1):300-7. Go to original source... Go to PubMed...
    6. Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH. A population-based study of inflicted traumatic brain injury in young children. JAMA 2003;290(5):621-6. Go to original source... Go to PubMed...
    7. Barlow KM, Minns RA. Annual incidence of shaken impact syndrome in young children. Lancet 2000;356(9241):1571-2. Go to original source... Go to PubMed...
    8. Talvik I, Metsvaht T, Leito K, Poder H, Kool P, Vali M, Lintrop M, Kolk A, Talvik T. Inflicted traumatic brain injury (ITBI) or shaken baby syndrome (SBS) in Estonia. Acta Paediatr 2006;95(7):799-804. Go to original source... Go to PubMed...
    9. Gunda D, Cornwell BO, Dahmoush HM, Jazbeh S, Alleman AM. Pediatric Central Nervous System Imaging of Nonaccidental Trauma: Beyond Subdural Hematomas. Radiographics 2019;39(1):213-28. Go to original source... Go to PubMed...
    10. Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome. A clinical, pathological, and biomechanical study. J Neurosurg 1987;66(3):409-15. Go to original source... Go to PubMed...
    11. Hettler J, Greenes DS. Can the Initial History Predict Whether a Child With a Head Injury Has Been Abused? Pediatrics 2003;111(3):602-7. Go to original source... Go to PubMed...
    12. Peters ML, Starling SP, Barnes-Eley ML, Heisler KW. The presence of bruising associated with fractures. Arch Pediatr Adolesc Med 2008;162(9):877-81. Go to original source... Go to PubMed...
    13. The Royal College of Radiologists, The Society and College of Radiographers. The radiological investigation of suspected physical abuse in children. Revised First Edition. 2018 [cited 2022 Oct 4]. Available from: https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr174_suspected_physical_abuse.pdf
    14. Wootton-Gorges SL, Soares BP, Alazraki AL, Anupindi SA, Blount JP, Booth TN, Dempsey ME, Falcone RA, Jr., Hayes LL, Kulkarni AV, Partap S, Rigsby CK, Ryan ME, Safdar NM, Trout AT, Widmann RF, Karmazyn BK, Palasis S. ACR Appropriateness Criteria((R)) Suspected Physical Abuse-Child. J Am Coll Radiol 2017;14(5S):S338-S49. Go to original source... Go to PubMed...
    15. Popelova E, Kyncl M, Specianova S. Postavme se na stranu dětí. Doporučení pro využití zobrazovacích metod při podezření na týrané dítě. 2021 [cited 2022 Oct 4]. Available from: http://www.crs.cz/media/File/pdf/DoporuceniPTD_e-verze_02.pdf (In Czech)
    16. Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA 1999;281(7):621-6. Go to original source... Go to PubMed...
    17. Paine CW, Scribano PV, Localio R, Wood JN. Development of Guidelines for Skeletal Survey in Young Children With Intracranial Hemorrhage. Pediatrics 2016;137(4):e20153024. Go to original source... Go to PubMed...
    18. Czech Statistical Office. Statistical Yearbook of the Czech Republic. 2021 [cited 2022 Oct 4]. Available from: https://www.czso.cz/csu/czso/4-population-13mb9tvai2
    19. Austin AE, Lesak AM, Shanahan ME. Risk and protective factors for child maltreatment: A review. Curr Epidemiol Rep 2020;7(4):334-42. Go to original source... Go to PubMed...
    20. The Ministry of Labour and Social Affairs. Annual report of child social protection services. 2020 [cited 2022 Jan 10]. Available from: https://www.mpsv.cz/statistiky-1
    21. Barber I, Perez-Rossello JM, Wilson CR, Kleinman PK. The yield of high-detail radiographic skeletal surveys in suspected infant abuse. Pediatr Radiol 2015;45(1):69-80. Go to original source... Go to PubMed...
    22. Paddock M, Sprigg A, Offiah AC. Imaging and reporting considerations for suspected physical abuse (non-accidental injury) in infants and young children. Part 1: initial considerations and appendicular skeleton. Clin Radiol 2017;72(3):179-88. Go to original source... Go to PubMed...
    23. Paddock M, Sprigg A, Offiah AC. Imaging and reporting considerations for suspected physical abuse (non-accidental injury) in infants and young children. Part 2: axial skeleton and differential diagnoses. Clin Radiol 2017;72(3):189-201. Go to original source... Go to PubMed...
    24. Wood JN, French B, Song L, Feudtner C. Evaluation for Occult Fractures in Injured Children. Pediatrics 2015;136(2):232-40. Go to original source... Go to PubMed...
    25. Lindberg DM, Beaty B, Juarez-Colunga E, Wood JN, Runyan DK. Testing for Abuse in Children With Sentinel Injuries. Pediatrics 2015;136(5):831-8. Go to original source... Go to PubMed...
    26. Popelova E, Rubesova E, Kyncl M, Rocek M. Non-accidental injury imaging in the Czech Republic: survey of current practice and of level of expertise of radiologists. Poster presented at: ESPR 2017 - 53rd Annual Meeting & 39th Post Graduate Course; Davos 2017.
    27. Nedorost E, Pecl J, Pinkasova T, Senkyrik J, Seehofnerova A, Horak O, Jabandziev P. Shaken baby syndrome. Pediatr praxi 2020;21:107-12. (In Czech) Go to original source...
    28. Peychl I. Abusive head trauma in infants and small children. Pediatr praxi 2020;21(2):74-8. (In Czech) Go to original source...
    29. Mihal V, Michalkova K, Petrova Z. Mnohočetné fraktury u kojence s chronickým subdurálnîm hematomem jako následek fyzického týránî? Pediatr praxi 2013;21(2):137-9. (In Czech)
    30. Wood JN, Feudtner C, Medina SP, Luan X, Localio R, Rubin DM. Variation in occult injury screening for children with suspected abuse in selected US children's hospitals. Pediatrics 2012;130(5):853-60. Go to original source... Go to PubMed...
    31. Offidani C, Villani A, Reale A, Marchili MR, Aufiero LR, Moras P, Lodise M, Raucci U, Barbieri MA, Raponi M. Early recognition of child abuse through screening indicators at the emergency department: experience of a tertiary urban pediatric hospital. Ital J Pediatr 2022;48(1):32. Go to original source... Go to PubMed...

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