Which investigation has a higher yield, skeletal survey (SS) or radionuclide imaging (RNI)?
- Nine studies were published published pre-1990; few studies published since 1998
- No study included oblique views of the ribs in the SS
- Rationales for choosing both investigations were not stated
Does repeat SS enhance detection?
- Oblique views of ribs not included in early studies
- Further clarification as to which infants merit follow-up skeletal survey would be of value
What views should be included in a SS?
- Older studies did not operate to current American College of Radiology / Royal College of Radiologists – Royal College of Paediatrics and Child Health national guidelines
- Decisions to include additional views (e.g. coned views) appear to be clinically determined, thus limiting their generalisability
Which children with suspected abuse should be investigated for occult fractures?
- All studies were retrospective
- The methodology of SS varied between studies and the indications for requesting a SS were ill-defined in some studies
- It was not possible to define the diagnostic yield of SS for two / three year olds
What other imaging modalities may enhance detection of occult fractures?
- Highly selected case series