Use of the skeletal survey in the evaluation of child maltreatment

Robert A. Belfer, Bruce L. Klein, Lavdena Orr

Research output: Contribution to journalArticlepeer-review

81 Scopus citations


The radiologic skeletal survey is an important tool for evaluating occult trauma in suspected child abuse. The purposes of this study were: (1) to determine the incidence of clinically unsuspected fractures detected by skeletal survey, and (2) to identify high-risk groups of children who would benefit from skeletal surveys. We retrospectively reviewed the medical records of 203 children admitted over a 30-month period to Children's National Medical Center for alleged physical abuse. Skeletal surveys were ordered based on the treating physicians' clinical suspicions. Patients in whom skeletal surveys were positive for an occult fracture were studied in more detail. There were 96 skeletal surveys performed; of these, 25 were positive for at least 1 clinically unsuspected fracture. Eighty percent of occult fractures were found in children younger than 1 year old. Presenting with a new fracture or an intracranial injury placed the child at higher risk of occult fracture. In contrast, patients with burn injuries had a very low yield of occult fractures. The patient's age and type of suspicious injury can help guide the physician as to when to obtain a skeletal survey.

Original languageEnglish (US)
Pages (from-to)122-124
Number of pages3
JournalAmerican Journal of Emergency Medicine
Issue number2
StatePublished - Jan 1 2001
Externally publishedYes


  • Child abuse
  • Occult fracture
  • Skeletal survey

ASJC Scopus subject areas

  • Emergency Medicine


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