J. Green3, R. N. Damle3, M. Hazeltine2, G. Keefe2, J. Brady2, P. P. Nazarey4, M. P. Hirsh4, J. T. Aidlen4 2University Of Massachusetts Medical School,School Of Medicine,Worcester, MA, USA 3University Of Massachusetts Medical School,General Surgery,Worcester, MA, USA 4University Of Massachusetts Medical School,Pediatric Surgery,Worcester, MA, USA
Introduction:
Skeletal survey is the imaging modality of choice to diagnose skeletal injury in Non-Accidental Trauma (NAT) victims under 2 years. Infants less than 6 months old are potentially the most vulnerable. We explore the utility of skeletal survey in our youngest trauma patients and its frequency of injury detection of NAT.
Methods:
A retrospective analysis of pediatric trauma patients (<18 years old) with a skeletal survey was performed at our institution from 2005-2015. Patients were divided into 2 groups: ≤6months and >6months to 3 years. Chi-squared analysis or Student t-test were performed when appropriate.
Results:
Our study identified 184 patients (98 patients were ≤6 months, 86 were >6 months to 3 years). There were no differences in race, gender, injury-severity-score or level of trauma. A positive skeletal survey was found in 16% of patients: 14% ≤6months and 19% >6months (p=0.43). Most common fractures identified on skeletal survey were long bone (24%), torso (15%), and skull (6.7%), with no statistical difference between groups. NAT was suspected in 58% of patients, with no difference between groups (58% vs. 57%, p=0.78). Head computed tomography(CT) scans were performed in 96% of patients ≤6 months old and just 66% of the patients older than 6 months (p<0.01).
Conclusion:
Skeletal surveys identify additional injuries at comparable rates in pediatric trauma patients regardless of age. Pediatric trauma patients 6 months old or younger are more likely to receive a head CT scan as part of their trauma workup.