Optimizing bone surveys performed for suspected non-accidental trauma with attention to maximizing diagnostic yield while minimizing radiation exposure: Utility of pelvic and lateral radiographs

Priyanka Jha, Rebecca Stein-Wexler, Kevin Coulter, J Anthony Seibert, Chin-Shang Li, Sandra L. Wootton-Gorges

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Skeletal surveys for non-accidental trauma (NAT) include lateral spinal and pelvic views, which have a significant radiation dose. Objective: To determine whether pelvic and lateral spinal radiographs should routinely be performed during initial bone surveys for suspected NAT. Materials and methods: The radiology database was queried for the period May 2005 to May 2011 using CPT codes for skeletal surveys for suspected NAT. Studies performed for skeletal dysplasia and follow-up surveys were excluded. Initial skeletal surveys were reviewed to identify fractures present, including those identified only on lateral spinal and/or pelvic radiographs. Clinical information and MR imaging was reviewed for the single patient with vertebral compression deformities. Results: Of the 530 children, 223 (42.1%) had rib and extremity fractures suspicious for NAT. No fractures were identified solely on pelvic radiographs. Only one child (<0.2%) had vertebral compression deformities identified on a lateral spinal radiograph. This infant had rib and extremity fractures and was clinically paraplegic. MR imaging confirmed the vertebral body fractures. Conclusion: Since no fractures were identified solely on pelvic radiographs and on lateral spinal radiographs in children without evidence of NAT, nor in nearly all with evidence of NAT, inclusion of these views in the initial evaluation of children for suspected NAT may not be warranted.

Original languageEnglish (US)
Pages (from-to)668-672
Number of pages5
JournalPediatric Radiology
Volume43
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Bone and Bones
Wounds and Injuries
Rib Fractures
Extremities
Current Procedural Terminology
Surveys and Questionnaires
Radiation Exposure
Radiology
Databases
Radiation

Keywords

  • Children
  • Lateral spine
  • Non-accidental trauma
  • Pelvic radiographs
  • Radiation dose reduction
  • Skeletal survey

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Pediatrics, Perinatology, and Child Health

Cite this

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title = "Optimizing bone surveys performed for suspected non-accidental trauma with attention to maximizing diagnostic yield while minimizing radiation exposure: Utility of pelvic and lateral radiographs",
abstract = "Background: Skeletal surveys for non-accidental trauma (NAT) include lateral spinal and pelvic views, which have a significant radiation dose. Objective: To determine whether pelvic and lateral spinal radiographs should routinely be performed during initial bone surveys for suspected NAT. Materials and methods: The radiology database was queried for the period May 2005 to May 2011 using CPT codes for skeletal surveys for suspected NAT. Studies performed for skeletal dysplasia and follow-up surveys were excluded. Initial skeletal surveys were reviewed to identify fractures present, including those identified only on lateral spinal and/or pelvic radiographs. Clinical information and MR imaging was reviewed for the single patient with vertebral compression deformities. Results: Of the 530 children, 223 (42.1{\%}) had rib and extremity fractures suspicious for NAT. No fractures were identified solely on pelvic radiographs. Only one child (<0.2{\%}) had vertebral compression deformities identified on a lateral spinal radiograph. This infant had rib and extremity fractures and was clinically paraplegic. MR imaging confirmed the vertebral body fractures. Conclusion: Since no fractures were identified solely on pelvic radiographs and on lateral spinal radiographs in children without evidence of NAT, nor in nearly all with evidence of NAT, inclusion of these views in the initial evaluation of children for suspected NAT may not be warranted.",
keywords = "Children, Lateral spine, Non-accidental trauma, Pelvic radiographs, Radiation dose reduction, Skeletal survey",
author = "Priyanka Jha and Rebecca Stein-Wexler and Kevin Coulter and Seibert, {J Anthony} and Chin-Shang Li and Wootton-Gorges, {Sandra L.}",
year = "2013",
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AU - Stein-Wexler, Rebecca

AU - Coulter, Kevin

AU - Seibert, J Anthony

AU - Li, Chin-Shang

AU - Wootton-Gorges, Sandra L.

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N2 - Background: Skeletal surveys for non-accidental trauma (NAT) include lateral spinal and pelvic views, which have a significant radiation dose. Objective: To determine whether pelvic and lateral spinal radiographs should routinely be performed during initial bone surveys for suspected NAT. Materials and methods: The radiology database was queried for the period May 2005 to May 2011 using CPT codes for skeletal surveys for suspected NAT. Studies performed for skeletal dysplasia and follow-up surveys were excluded. Initial skeletal surveys were reviewed to identify fractures present, including those identified only on lateral spinal and/or pelvic radiographs. Clinical information and MR imaging was reviewed for the single patient with vertebral compression deformities. Results: Of the 530 children, 223 (42.1%) had rib and extremity fractures suspicious for NAT. No fractures were identified solely on pelvic radiographs. Only one child (<0.2%) had vertebral compression deformities identified on a lateral spinal radiograph. This infant had rib and extremity fractures and was clinically paraplegic. MR imaging confirmed the vertebral body fractures. Conclusion: Since no fractures were identified solely on pelvic radiographs and on lateral spinal radiographs in children without evidence of NAT, nor in nearly all with evidence of NAT, inclusion of these views in the initial evaluation of children for suspected NAT may not be warranted.

AB - Background: Skeletal surveys for non-accidental trauma (NAT) include lateral spinal and pelvic views, which have a significant radiation dose. Objective: To determine whether pelvic and lateral spinal radiographs should routinely be performed during initial bone surveys for suspected NAT. Materials and methods: The radiology database was queried for the period May 2005 to May 2011 using CPT codes for skeletal surveys for suspected NAT. Studies performed for skeletal dysplasia and follow-up surveys were excluded. Initial skeletal surveys were reviewed to identify fractures present, including those identified only on lateral spinal and/or pelvic radiographs. Clinical information and MR imaging was reviewed for the single patient with vertebral compression deformities. Results: Of the 530 children, 223 (42.1%) had rib and extremity fractures suspicious for NAT. No fractures were identified solely on pelvic radiographs. Only one child (<0.2%) had vertebral compression deformities identified on a lateral spinal radiograph. This infant had rib and extremity fractures and was clinically paraplegic. MR imaging confirmed the vertebral body fractures. Conclusion: Since no fractures were identified solely on pelvic radiographs and on lateral spinal radiographs in children without evidence of NAT, nor in nearly all with evidence of NAT, inclusion of these views in the initial evaluation of children for suspected NAT may not be warranted.

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