{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:24:49Z","timestamp":1791973489962,"version":"4.4.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T00:00:00Z","timestamp":1575331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T00:00:00Z","timestamp":1575331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000858","name":"University of Sheffield","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000858","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Objectives<\/jats:title>\n<jats:p>To assess whether head CT with 3D reconstruction can replace skull radiographs (SXR) in the imaging investigation of suspected physical abuse (SPA)\/abusive head trauma (AHT).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>PACS was interrogated for antemortem skeletal surveys performed for SPA, patients younger than 2\u00a0years, SXR and CT performed within 4\u00a0days of each other. Paired SXR and CT were independently reviewed. One reviewer analysed CT without and (3\u00a0months later) with 3D reconstructions. SXR and CT expert consensus review formed the gold standard. Observer reliability was calculated.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 104 SXR\/CT examination pairs were identified, mean age 6.75\u00a0months (range 4\u00a0days to 2\u00a0years); 21 (20%) had skull fractures; two fractures on CT were missed on SXR. There were no fractures on SXR that were not seen on CT. For SXR and CT, respectively: PPV reviewer 1, 95% confidence interval (CI) 48\u201382% and 85\u2013100%; reviewer 2, 67\u201398% and 82\u2013100%; and NPV reviewer 1, 95%, CI 88\u201398% and 96\u2013100%; reviewer 2, 88\u201397% and 88\u201398%. Inter- and intra-observer reliability were respectively the following: SXR, excellent (kappa\u2009=\u20090.831) and good (kappa\u2009=\u20090.694); CT, excellent (kappa\u2009=\u20090.831) and perfect (kappa\u2009=\u20091). All results were statistically significant (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>CT has greater diagnostic accuracy than SXR in detecting skull fractures which is increased on concurrent review of 3D reconstructions and should be performed in every case of SPA\/AHT. SXR does not add further diagnostic information and can be omitted from the skeletal survey when CT with 3D reconstruction is going to be, or has been, performed.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Key Points<\/jats:title>\n<jats:p><jats:italic>\u2022 Head CT with 3D reconstruction is more sensitive and specific for the diagnosis of skull fractures.<\/jats:italic><\/jats:p>\n<jats:p><jats:italic>\u2022 Skull radiographs can be safely omitted from the initial skeletal survey performed for suspected physical abuse when head CT with 3D reconstruction is going to be, or has been, performed<\/jats:italic>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00330-019-06579-w","type":"journal-article","created":{"date-parts":[[2019,12,3]],"date-time":"2019-12-03T12:03:25Z","timestamp":1575374605000},"page":"1480-1487","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Avoiding skull radiographs in infants with suspected inflicted injury who also undergo head CT: \u201ca no-brainer?\u201d"],"prefix":"10.1007","volume":"30","author":[{"given":"Andrew","family":"Martin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Paddock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Johns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Smith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok","family":"Raghavan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J. 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However, this study was registered with our local Research and Development and Audit office following which service evaluation approval was received.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was not required because this was a retrospective study of anonymised images. However, this study was registered with our local Research and Development and Audit office following which Service Evaluation approval was received.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"\u2022 Retrospective\u2022 Observational\u2022 Performed at one institution","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}