Diagnostic Yield of Skeletal Survey in Pediatric Trauma Patients by Age

Abstract

Introduction: Non-accidental Trauma (NAT) is a major cause of morbidity and mortality in children. Younger children are at greater risk of NAT. In this observational study, we determine if there is an association between a child’s age, frequency of positive of skeletal surveys and the types of injuries discovered in pediatric patients undergoing a trauma work up.
Methods:  The study sample consisted of all pediatric trauma patients < 3 years old, who had skeletal surveys performed at a tertiary care center between 2005 and 2015. Patients were divided into two age groups: ?6months old (n=98) and >6months old (n=86). The utilization of a skeletal survey, frequency of confirmed NAT, and injuries were compared between these 2 age groups.
Results: The average age of this population was 8.4 months, 56.0% were boys, and 62.5% were Caucasian. A positive skeletal survey was found in 14.3% of patients ?6months old and 18.6% of patients >6months old (p=0.43).  The most common fractures identified were long bone (50.0%), torso (30.4%), and skull (13.0%). Similar frequencies of NAT were observed between those less than and older than 6 months (58.2% vs. 57.0%). Head computed tomography (CT) scans were performed in the majority (95.9%) of patients ?6 months old and in 66.3% of patients >6 months old (p < 0.01).
Conclusion: Skeletal surveys identify additional injuries at comparable rates in pediatric trauma patients regardless of age. Advanced imaging differs in younger and older pediatric trauma patients undergoing skeletal survey.