The Role of Skeletal Survey in Identifying Non-Accidental Trauma in Pediatric Trauma Patients

Abstract

Background: Non-accidental Trauma (NAT) is a major cause of morbidity and mortality in children. Children less than 2 years old are at greater risk of NAT than older children. A skeletal survey is a series of X-rays of all the bones in the body, or at least the axial skeleton and the large cortical bones used to identify NAT in children. In this observational study, we examined the association between a child’s age, frequency of positive 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 single tertiary care center in Central Massachusetts 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 the sample 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 while in only 66.3% of patients > 6 months old (p < 0.01). Conclusions: Skeletal surveys identify injuries at comparable rates in pediatric trauma patients regardless of age. Advanced imaging differs in younger and older pediatric trauma patients undergoing skeletal survey.