ArticlePediatric surgery international2020
Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital.
Article in Pediatric surgery international, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
4 citing papers in PubMed, 5 citations in OpenAlex.
- The impact of a quality assurance programme on skeletal survey imaging for suspected non-accidental injury.The British journal of radiology · 2025Article
- Yield of skeletal surveys in national network of child abuse pediatricians: Age is key.Child abuse & neglect · 2024Observational
- Identification and Evaluation of Non-Accidental Trauma in the Pediatric Population: A Clinical Review.Children (Basel, Switzerland) · 2024Review
- Asymptomatic Infant Rib Fractures Are Primarily Non-abuse-Related and Should Not Be Used to Assess Physical Child Abuse.Children (Basel, Switzerland) · 2023Article
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
purposeThe purpose of the study was to determine the rate of occult fractures (without clinical symptoms) per presenting clinical injury i.e., children presenting with a fracture, bruise, abusive head trauma and the types of fracture most likely to be found, in a series of infants and young children suspected of being victims of NAT.
methodsSkeletal surveys done between 2008 and 2018 of children (< 5 years) were retrospectively analyzed. Both radiographs of admitted children and reassessment images from all over the country were included and reviewed by a forensic paediatric radiologist. Deceased children were excluded. Variables as gender, age, initial clinical injury and occult fractures were collected. Occult fractures on the follow-up skeletal survey were collected.
resultsA total of 370 skeletal surveys of 296 children were included. Median age was 22 weeks (IQR 11-48), there were 172 (58%) boys. A total of 195 occult fractures were detected in 111 (32%) children. Occult fractures were detected in 37/126 (29%) children with fracture as presenting symptom, 33/90 (37%) children with head trauma and 26/50 (52%) children with bruises. Rib (n = 56, 50%) and lower leg (n = 40, 36%) fractures were most detected.
conclusionOccult fractures were detected in 32% of the children. Occult fractures were most prevalent if the initial clinical injury suggestive for NAT to request skeletal survey was a bruise, abusive head trauma or fracture.
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