Follow-up skeletal survey use by child abuse pediatricians

Nancy S. Harper, Terri Lewis, Sonja Eddleman, Daniel M. Lindberg, Jayme Coffman, Deb Bretl, Nancy Harper, Katherine Deye, Antoinette L. Laskey, Tara Harris, Yolanda Duralde, Marcella Donaruma-Kwoh, Daryl Steiner, Ken Feldman, Kimberly Schwartz, Robert A. Shapiro, Mary Greiner, Alice Newton, Rachel Berger, Ivone KimKent Hymel, Suzanne Haney, Alicia Pekarsky, Andrea Asnes, Paul McPherson, Neha Mehta, Gwendolyn Gladstone

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Skeletal survey is frequently used to identify occult fractures in young children with concern for physical abuse. Because skeletal survey is relatively insensitive for some abusive fractures, a follow-up skeletal survey (FUSS) may be undertaken at least 10-14 days after the initial skeletal survey to improve sensitivity for healing fractures. This was a prospectively planned secondary analysis of a prospective, observational study of 2,890 children who underwent subspecialty evaluation for suspected child physical abuse at 1 of 19 centers. Our objective was to determine variability between sites in rates of FUSS recommendation, completion and fracture identification among the 2,049 participants who had an initial SS. Among children with an initial skeletal survey, the rate of FUSS recommendation for sites ranged from 20% to 97%; the rate of FUSS completion ranged from 10% to 100%. Among sites completing at least 10 FUSS, rates of new fracture identification ranged from 8% to 28%. Among completed FUSS, new fractures were more likely to be identified in younger children, children with higher initial level of concern for abuse, and those with a fracture or cutaneous injury identified in the initial evaluation. The current variability in FUSS utilization is not explained by variability in occult fracture prevalence. Specific guidelines for FUSS utilization are needed.

Original languageEnglish (US)
Pages (from-to)336-342
Number of pages7
JournalChild Abuse and Neglect
StatePublished - Jan 1 2016

Bibliographical note

Funding Information:
This project was supported by a grant from the Health Resources and Services Administration/Maternal and Child Health Bureau, Emergency Medical Services for Children Program ( H34MC19346-01-02 ). The funder played no role design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Publisher Copyright:
© 2015 Elsevier Ltd.


  • Follow-up skeletal survey
  • Fracture
  • Physical abuse
  • Variability


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