Pediatric Radiology

, Volume 45, Issue 1, pp 69–80 | Cite as

The yield of high-detail radiographic skeletal surveys in suspected infant abuse

  • Ignasi BarberEmail author
  • Jeannette M. Perez-Rossello
  • Celeste R. Wilson
  • Paul K. Kleinman
Original Article



Skeletal surveys are routinely performed in cases of suspected child abuse, but there are limited data regarding the yield of high-detail skeletal surveys in infants.


To determine the diagnostic yield of high-detail radiographic skeletal surveys in suspected infant abuse.

Material and methods

We reviewed the high-detail American College of Radiology standardized skeletal surveys performed for suspected abuse in 567 infants (median: 4.4 months, SD 3.47; range: 4 days-12 months) at a large urban children’s hospital between 2005 and 2013. Skeletal survey images, radiology reports and medical records were reviewed. A skeletal survey was considered positive when it showed at least one unsuspected fracture.


In 313 of 567 infants (55%), 1,029 definite fractures were found. Twenty-one percent (119/567) of the patients had a positive skeletal survey with a total of 789 (77%) unsuspected fractures. Long-bone fractures were the most common injuries, present in 145 children (26%). The skull was the site of fracture in 138 infants (24%); rib cage in 77 (14%), clavicle in 24 (4.2%) and uncommon fractures (including spine, scapula, hands and feet and pelvis) were noted in 26 infants (4.6%). Of the 425 infants with neuroimaging, 154 (36%) had intracranial injury. No significant correlation between positive skeletal survey and associated intracranial injury was found. Scapular fractures and complex skull fractures showed a statistically significant correlation with intracranial injury (P = 0.029, P = 0.007, respectively).


Previously unsuspected fractures are noted on skeletal surveys in 20% of cases of suspected infant abuse. These data may be helpful in the design and optimization of global skeletal imaging in this vulnerable population.


Child abuse Skeletal survey Fracture Infant Classic metaphyseal lesion 


Conflicts of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Ignasi Barber
    • 1
    Email author
  • Jeannette M. Perez-Rossello
    • 2
  • Celeste R. Wilson
    • 3
  • Paul K. Kleinman
    • 2
  1. 1.Pediatric Radiology DepartmentHospital Vall d’Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
  2. 2.Radiology DepartmentBoston Children’s HospitalBostonUSA
  3. 3.Division of General PediatricsBoston Children’s HospitalBostonUSA

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