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Guidelines for skeletal survey in young children with fractures
  1. Kevin Borg1,
  2. Deborah Hodes2
  1. 1University College London Hospital (UCLH) UK and Mater Dei Hospital Msida, London, UK
  2. 2University College London Hospital (UCLH) and Royal Free Hospital London, London, UK
  1. Correspondence to Dr Kevin Borg, University College London Hospital (UCLH) UK and Mater Dei Hospital Msida, Malta, UCLH, 250 Euston Road London NW1 2PG, UK; kevin.d.borg{at}gov.mt and kevin.borg{at}nhs.net

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Information about current guideline

‘Development of guidelines for skeletal survey in young children with fractures’ is an American guideline by Wood et al published in the journal Pediatrics in June 2014.1 The aim of this study was to devise guidelines on when to carry out an initial skeletal survey (SS) in children less than 24 months of age with fractures, based on available evidence and expert opinions from diverse paediatric specialties.

Previous guideline

There are no previous published guidelines on the exact indications to when an initial SS should be performed in children less than 24 months of age.

In 2008, the Royal College of Radiologists (RCR) and the Royal College of Paediatrics and Child Health (RCPCH) published guidance on standards in radiological investigations of suspected non-accidental injury (NAI).2 They recommend that ‘a full skeletal survey should always be performed’ as an initial imaging method in children under 2 years of age who are undergoing a clinical investigation for suspected physical abuse. This guidance is also cited in the RCPCH child protection companion published in 2013.3 In 2009, the American Academy of Pediatrics (AAP) also highlighted that a SS is ‘mandatory in all cases of suspected physical abuse’ in this age group4 and reiterated this in their updated 2014 publication that provides further guidance to health professionals when to consider NAI as the cause of fractures5 (box 1).

Box 1

Resources

  1. Link to paper ‘Development of guidelines for skeletal survey in young children with fractures’ http://pediatrics.aappublications.org/content/early/2014/06/10/peds.2013-3242.full.pdf+html

  2. Link to 2008 RCH/RCPCH Standards for radiological investigations of suspected non-accidental injury. http://www.rcpch.ac.uk/sites/default/files/asset_library/Publications/S/StandardsforRadiologicalInvestigationsD.pdf

  3. Link to 2009 paper by the AAP, ‘Diagnostic imaging of child abuse’ http://pediatrics.aappublications.org/content/123/5/1430.full.pdf+html

  4. Link to 2014 paper by the AAP, ‘Evaluating children …

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