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Limitations of review findings

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



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