Comparison of bone scans with child bone surveys in children under one year of age, with diagnosis of suspected non-accidental trauma

Objectives Both bone scans and skeletal surveys are used to diagnose bone fractures in children with a diagnosis of suspected physical abuse. We investigate the necessity of the combination of these two exams to rule out fractures in children less than one year of age.

Methods Twenty cases were evaluated using both modalities of diagnostic exams (child bone survey and bone scan). “Blind” readings of the bone scan by a Nuclear Medicine Physician and of the child bone survey by a Radiologist were performed. Skeletal fractures were categorized as definite, possible, or doubtful by the readers. Findings were then compared.

Results Of the 20 cases reviewed, 17 cases demonstrated evidence of fracture(s) on the child bone survey and/or the bone scan. Matched negative findings of fracture were noted on 3 of the cases reviewed. Five cases involved mismatched findings of fracture (scans showed fracture(s) in different areas). Four skeletal surveys (20%) were definite or possible for fracture, with negative bone scan. Two bone scans (10%) were definite or possible for fracture, with negative skeletal survey. Overall, the radiologic osseous survey proved to be more sensitive than the nuclear medicine bone scan in 40% of the cases, while the bone scan demonstrated a higher sensitivity for fracture detection in 25% of the subjects.

Conclusions Nuclear medicine bone scans and radiologic osseous surveys are complementary tools used to diagnose child abuse fractures in young patients. A child bone survey should be considered for the initial evaluation of non-accidental trauma in children under the age of one year. If, however, the osseous survey is read as negative or equivical and there is suspicion for abuse, a nuclear medicine bone scan should be recommended