ArticlePediatric radiology2017
Double-read of skeletal surveys in suspected non-accidental trauma: what we learned.
Article in Pediatric radiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 18 citations in OpenAlex.
- Fractures in suspected child abuse: A critical review of the evidence cited by the American Academy of Pediatrics and Royal College of Paediatrics and Child Health.Forensic science international. Synergy · 2026Article
- Outcomes of indeterminate fractures identified on skeletal surveys obtained during non-accidental trauma evaluations.Child abuse & neglect · 2026Article
- Evaluation of ultra-low and low-dose CT skeletal survey for fracture detection in assessments for suspected non-accidental injury: a prospective post-mortem study.Skeletal radiology · 2026Article
- Research on re-searching: interrupted foraging is not disrupted foraging.Cognitive research: principles and implications · 2024Article
- Professional practice and awareness of child abuse among radiologists and radiologic technologists: results from Saudi Arabia.Pediatric radiology · 2023Article
- Current utilization of pediatric postmortem imaging in North America: a questionnaire-based survey.Pediatric radiology · 2023Article
- Machine learning to identify distal tibial classic metaphyseal lesions of infant abuse: a pilot study.Pediatric radiology · 2022Article
- Fatal non-accidental injury in South Africa: A Gauteng hospital's perspective on the incidence and fracture types in post-mortem skeletal surveys.SA journal of radiology · 2022Article
- A call to action: education of radiology residents in child abuse imaging.Pediatric radiology · 2021Article
- Fractures of child abuse.Pediatric radiology · 2021Review
- The radiology report in child abuse.Pediatric radiology · 2021Review
- The added value of a second read by pediatric radiologists for outside skeletal surveys.Pediatric radiology · 2019Article
- Imaging of non-accidental injury; what is clinical best practice?Journal of medical radiation sciences · 2018Review
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMissing a fracture in a child on skeletal surveys for suspected non-accidental trauma can have devastating results. Double-read has the potential to improve fracture detection. However the yield of double-read is unknown.
objectiveTo determine the advantage of double-read versus single-read of radiographic skeletal surveys for suspected non-accidental trauma. MATERIALS AND
methodsThe study was performed in two phases. In the first phase (April 2013 to September 2013), double-read was performed for all skeletal surveys obtained during weekday working hours. Because we had no new double-read findings in studies initially read as negative, we conducted a second phase (January 2014 to March 2014). In the second phase we limited double-reads to skeletal surveys found positive on the first read. At the end of this period, we retrospectively performed double-read for all initially negative skeletal surveys. We excluded follow-up skeletal surveys. The difference in discrepancy (new fracture or false diagnosis of a fracture) ratio between negative and positive skeletal surveys was evaluated using the Fisher exact test, and change in discrepancy ratio between the first and second study phases was evaluated using the stratified Cochran-Mantel-Haenszel test.
resultsOverall in the two phases, 178 skeletal surveys were performed in 178 children (67 girls) with mean age of 9 months (range 3 days to 3.7 years). Double-read found 16 discrepancies in 8/178 (4.5%) skeletal surveys. Seven of these studies showed additional fractures (n=15). In one study, an initial read of a skull fracture was read as a variant on the second read. There was a significant (P=0.01) difference between rate of disagreement in negative skeletal surveys (1/104, 1.0%) and positive skeletal surveys (7/74, 9.5%). No significant change in disagreement rate was demonstrated between the two phases of the study (P=0.59).
conclusionDouble-read of skeletal survey for suspected non-accidental trauma found false-negative fractures in a few cases and rarely found false-positive diagnosis of a fracture. Double-read uncommonly found discrepancies in an initially normal skeletal survey. Limiting double-read to initially positive studies improves the yield of the double-read.
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