Vol 1 No 1 (2018): Current Issue
Research Article

Diagnostic Yield of Skeletal Survey in Pediatric Trauma Patients by Age

Green J
Department of Surgery, University of Massachusetts Medical School, Worcester MA, USA
Hazeltine M
Department of Surgery, University of Massachusetts Medical School, Worcester MA, USA
Damle RN
Division of Pediatric Surgery, St. Louis University Medical School, St. Louis MO, USA
Nazarey PP
Division of Pediatric Surgery, University of Massachusetts Medical School, Worcester MA, USA
Hirsh MP
Division of Pediatric Surgery, University of Massachusetts Medical School, Worcester MA, USA
Aidlen JT
Division of Pediatric Surgery, University of Massachusetts Medical School, Worcester MA, USA
Published June 12, 2018
Keywords
  • Child abuse,
  • Clinical care,
  • Pediatric trauma,
  • Non-Accidental trauma

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.

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