@article{ref1,
title="Who are we missing? Too few skeletal surveys for children with humeral and femoral fractures",
journal="Clinical radiology",
year="2014",
author="Shelmerdine, Susan C. and Das, R. and Ingram, M. D. and Negus, S.",
volume="69",
number="12",
pages="e512-6",
abstract="AIM: To determine the potential shortfall in skeletal survey referral for children presenting with an acute non-supracondylar humeral or femoral fracture. <br><br>MATERIALS AND METHODS: Plain radiograph reports were reviewed retrospectively using the radiology information system database over a 5 year study period (May 2008-2013) in children under 18 months of age who presented with an acute fracture. Subsequent skeletal survey referral was used as a surrogate marker for further investigation of child abuse. Application of robust meta-analysis derived probability data regarding likelihood of child abuse as a cause of non-supracondylar humeral or femoral fracture was applied. An estimation of the expected number of cases of abuse, with shortfall in skeletal survey referrals, was then calculated. <br><br>RESULTS: There were 288 fractures in 281 children. Three children presented with multiple fractures and were considered separately in the present data. The mean patient age was 10.5 months. Nine (3%) non-supracondylar humeral fractures were identified of which four cases may have been due to non-accidental injury (NAI). One (11%) of these patients was referred for a skeletal survey indicating a potential shortfall of three referrals. Twenty-five (9%) femoral fractures were identified of which 13 cases may have been due to NAI, with six (24%) referrals for skeletal surveys generated. This indicates a potential shortfall of seven referrals. <br><br>CONCLUSION: The present study serves as a current analysis of practice within a tertiary paediatric referral centre. There appeared to be local under-investigation of NAI. Improved child protection education and awareness programmes have now been introduced.<p /> <p>Language: en</p>",
language="en",
issn="0009-9260",
doi="10.1016/j.crad.2014.08.014",
url="http://dx.doi.org/10.1016/j.crad.2014.08.014"
}