{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:22:37Z","timestamp":1784629357258,"version":"3.55.0"},"reference-count":27,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,1,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVES:<\/jats:title><jats:p>The goals were to assess the use of the skeletal survey (SS) to evaluate for physical abuse in a large consecutive sample, to identify characteristics of children most likely to have unsuspected fractures, and to determine how often SS results influenced directly the decision to make a diagnosis of abuse.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>A retrospective, descriptive study of a consecutive sample of children who underwent an SS at a single children's hospital over 4 years was performed. Data on demographic characteristics, clinical presentation, SS results, and effects of SS results on clinical diagnoses were collected. A positive SS result was defined as a SS which identified a previously unsuspected fracture(s).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>Of the 703 SSs, 10.8% yielded positive results. Children &amp;lt;6 months of age, children with an apparent life-threatening event or seizure, and children with suspected abusive head trauma had the highest rates of positive SS results. Of children with positive SS results, 79% had \u22651 healing fracture.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>This is the largest study to date to describe the use of the SS. Almost 11% of SS results were positive. The SS results influenced directly the decision to make a diagnosis of abuse for 50% of children with positive SS results. These data, combined with the high morbidity rates for missed abuse and the large proportion of children with healing fractures detected through SS, suggest that broader use of SS, particularly for high-risk populations, may be warranted.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2010-0298","type":"journal-article","created":{"date-parts":[[2010,12,14]],"date-time":"2010-12-14T04:32:50Z","timestamp":1292301170000},"page":"e47-e52","source":"Crossref","is-referenced-by-count":116,"title":["Use of Skeletal Surveys to Evaluate for Physical Abuse: Analysis of 703 Consecutive Skeletal Surveys"],"prefix":"10.1542","volume":"127","author":[{"given":"Shanna O.","family":"Duffy","sequence":"first","affiliation":[{"name":"Boonshoft School of Medicine, Wright State University, Dayton, Ohio; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Squires","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet B.","family":"Fromkin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel P.","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2011,1,1]]},"reference":[{"issue":"1","key":"2021120900244462200_B1","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1542\/peds.108.1.206","article-title":"Shaken baby syndrome: rotational cranial injuries: technical report","volume":"108","author":"American Academy of Pediatrics, Committee on Child Abuse and Neglect","year":"2001","journal-title":"Pediatrics"},{"issue":"1","key":"2021120900244462200_B2","first-page":"58","article-title":"Serial abuse in children who are shaken","volume":"144","author":"Alexander","year":"1990","journal-title":"Am J Dis Child"},{"issue":"4","key":"2021120900244462200_B3","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/01.pec.0000208180.94166.dd","article-title":"Child abuse fatalities: are we missing opportunities for intervention?","volume":"22","author":"King","year":"2006","journal-title":"Pediatr Emerg Care"},{"issue":"12","key":"2021120900244462200_B4","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1097\/PEC.0b013e31818e9f5d","article-title":"Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse","volume":"24","author":"Oral","year":"2008","journal-title":"Pediatr Emerg Care"},{"issue":"6","key":"2021120900244462200_B5","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1097\/01.TA.0000145076.05111.E1","article-title":"The tip of the iceberg for child abuse: the critical roles of the pediatric trauma service and its registry","volume":"57","author":"Chang","year":"2004","journal-title":"J Trauma"},{"issue":"5","key":"2021120900244462200_B6","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1542\/peds.2009-0558","article-title":"Diagnostic imaging of child abuse","volume":"123","author":"American Academy of Pediatrics, Section on Radiology","year":"2009","journal-title":"Pediatrics"},{"issue":"1","key":"2021120900244462200_B7","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2004-2649","article-title":"Reasonable suspicion: a study of Pennsylvania pediatricians regarding child abuse","volume":"116","author":"Levi","year":"2005","journal-title":"Pediatrics"},{"issue":"4","key":"2021120900244462200_B8","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.chiabu.2005.05.004","article-title":"Reasonable suspicion: a pilot study of pediatric residents","volume":"30","author":"Levi","year":"2006","journal-title":"Child Abuse Negl"},{"issue":"4","key":"2021120900244462200_B9","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1007\/s11017-004-3136-8","article-title":"Index of suspicion: feeling not believing","volume":"25","author":"Levi","year":"2004","journal-title":"Theor Med Bioeth"},{"issue":"2","key":"2021120900244462200_B10","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1148\/radiology.146.2.6849085","article-title":"The abused child: a radiological reappraisal","volume":"146","author":"Merten","year":"1983","journal-title":"Radiology"},{"issue":"2","key":"2021120900244462200_B11","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1053\/ajem.2001.21345","article-title":"Use of the skeletal survey in the evaluation of child maltreatment","volume":"19","author":"Belfer","year":"2001","journal-title":"Am J Emerg Med"},{"issue":"2","key":"2021120900244462200_B12","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jcfm.2005.08.001","article-title":"A retrospective case series of skeletal surveys in children with suspected non-accidental injury","volume":"13","author":"Day","year":"2006","journal-title":"J Clin Forensic Med"},{"issue":"3","key":"2021120900244462200_B13","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1542\/peds.99.3.371","article-title":"Coagulopathy in pediatric abusive head trauma","volume":"99","author":"Hymel","year":"1997","journal-title":"Pediatrics"},{"issue":"7","key":"2021120900244462200_B14","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1001\/jama.281.7.621","article-title":"Analysis of missed cases of abusive head trauma","volume":"281","author":"Jenny","year":"1999","journal-title":"JAMA"},{"issue":"5","key":"2021120900244462200_B15","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1001\/jama.290.5.621","article-title":"A population-based study of inflicted traumatic brain injury in young children","volume":"290","author":"Keenan","year":"2003","journal-title":"JAMA"},{"key":"2021120900244462200_B16","first-page":"61","article-title":"Serum neuron-specific enolase, S100B, and myelin basic protein concentrations after inflicted and noninflicted traumatic brain injury in children","volume":"103","author":"Berger","year":"2005","journal-title":"J Neurosurg"},{"issue":"4\u20135","key":"2021120900244462200_B17","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1159\/000094158","article-title":"Serum biomarkers after traumatic and hypoxemic brain injuries: insight into the biochemical response of the pediatric brain to inflicted brain injury","volume":"28","author":"Berger","year":"2006","journal-title":"Dev Neurosci"},{"issue":"2","key":"2021120900244462200_B18","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1542\/peds.2005-0711","article-title":"Identification of inflicted traumatic brain injury in well-appearing infants using serum and cerebrospinal markers: a possible screening tool","volume":"117","author":"Berger","year":"2006","journal-title":"Pediatrics"},{"issue":"10","key":"2021120900244462200_B19","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.chiabu.2004.06.006","article-title":"Abusive head trauma in young children: characteristics and medical charges in a hospitalized population","volume":"28","author":"Ettaro","year":"2004","journal-title":"Child Abuse Negl"},{"issue":"6","key":"2021120900244462200_B20","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1542\/peds.74.6.1075","article-title":"Value of radiologic skeletal survey in assessment of abused children","volume":"74","author":"Ellerstein","year":"1984","journal-title":"Pediatrics"},{"issue":"1","key":"2021120900244462200_B21","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1542\/peds.2008-3794","article-title":"Delayed identification of pediatric abuse-related fractures","volume":"125","author":"Ravichandiran","year":"2010","journal-title":"Pediatrics"},{"issue":"4","key":"2021120900244462200_B22","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1177\/112067210701700426","article-title":"Ophthalmologic findings in infants after an apparent life-threatening event","volume":"17","author":"Altman","year":"2007","journal-title":"Eur J Ophthalmol"},{"issue":"1","key":"2021120900244462200_B23","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1542\/peds.2007-3376","article-title":"Death, child abuse, and adverse neurological outcome of infants after an apparent life-threatening event","volume":"122","author":"Bonkowsky","year":"2008","journal-title":"Pediatrics"},{"issue":"9","key":"2021120900244462200_B24","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1177\/0009922808320595","article-title":"Clues that aid in the diagnosis of nonaccidental trauma presenting as an apparent life-threatening event","volume":"47","author":"Vellody","year":"2008","journal-title":"Clin Pediatr (Phila)"},{"issue":"4","key":"2021120900244462200_B25","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1097\/01.pec.0000210176.48386.ae","article-title":"Apparent life-threatening event or child abuse?","volume":"22","author":"Waseem","year":"2006","journal-title":"Pediatr Emerg Care"},{"issue":"4","key":"2021120900244462200_B26","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1542\/peds.2004-0847","article-title":"Yield of diagnostic testing in infants who have had an apparent life-threatening event","volume":"115","author":"Brand","year":"2005","journal-title":"Pediatrics"},{"issue":"2","key":"2021120900244462200_B27","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2008-2467","article-title":"Skeletal surveys in infants with isolated skull fractures","volume":"123","author":"Wood","year":"2009","journal-title":"Pediatrics"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/127\/1\/e47\/910666\/zpe00111000e47.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/127\/1\/e47\/910666\/zpe00111000e47.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,4]],"date-time":"2023-06-04T13:32:34Z","timestamp":1685885554000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/127\/1\/e47\/30106\/Use-of-Skeletal-Surveys-to-Evaluate-for-Physical"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,1,1]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2011,1,1]]},"published-print":{"date-parts":[[2011,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2010-0298","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,1,1]]}}}