{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:16:54Z","timestamp":1791253014808,"version":"4.1.0"},"reference-count":42,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,2,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE:<\/jats:title>\n                  <jats:p>To develop guidelines for performing an initial skeletal survey (SS) for children &amp;lt;24 months of age presenting with bruising in the hospital setting, combining available evidence with expert opinion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>Applying the Rand\/UCLA Appropriateness Method, a multispecialty panel of 10 experts relied on evidence from the literature and their own clinical expertise in rating the appropriateness of performing SS for 198 clinical scenarios characterizing children &amp;lt;24 months old with bruising. After a moderated discussion of initial ratings, the scenarios were revised. Panelists re-rated SS appropriateness for 219 revised scenarios. For the 136 clinical scenarios in which SS was deemed appropriate, the panel finally assessed the necessity of SS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Panelists agreed that SS is \u201cappropriate\u201d for 62% (136\/219) of scenarios, and \u201cinappropriate\u201d for children \u226512 months old with nonpatterned bruising on bony prominences. Panelists agreed that SS is \u201cnecessary\u201d for 95% (129\/136) of the appropriate scenarios. SS was deemed necessary for infants &amp;lt;6 months old regardless of bruise location, with rare exceptions, but the necessity of SS in older children depends on bruise location. According to the panelists, bruising on the cheek, eye area, ear, neck, upper arm, upper leg, hand, foot, torso, buttock, or genital area necessitates SS in children &amp;lt;12 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>The appropriateness and necessity of SS in children presenting for care to the hospital setting with bruising, as determined by a diverse panel of experts, depends on age of the child and location of bruising.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2014-2169","type":"journal-article","created":{"date-parts":[[2015,1,20]],"date-time":"2015-01-20T03:52:49Z","timestamp":1421725969000},"page":"e312-e320","source":"Crossref","is-referenced-by-count":35,"title":["Development of Hospital-Based Guidelines for Skeletal Survey in Young Children With Bruises"],"prefix":"10.1542","volume":"135","author":[{"given":"Joanne N.","family":"Wood","sequence":"first","affiliation":[{"name":"Division of General Pediatrics and PolicyLab, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and"},{"name":"Leonard Davis Institute of Health Economics and"},{"name":"Departments of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oludolapo","family":"Fakeye","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics and PolicyLab, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Mondestin","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics and PolicyLab, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Rubin","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics and PolicyLab, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and"},{"name":"Leonard Davis Institute of Health Economics and"},{"name":"Departments of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Localio","sequence":"additional","affiliation":[{"name":"Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Feudtner","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics and PolicyLab, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania; and"},{"name":"Leonard Davis Institute of Health Economics and"},{"name":"Departments of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2015,2,1]]},"reference":[{"issue":"2","key":"2021120907024435600_B1","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1136\/archdischild-2013-304339","article-title":"Bruising in children who are assessed for suspected physical abuse.","volume":"99","author":"Kemp","year":"2014","journal-title":"Arch Dis Child"},{"issue":"1","key":"2021120907024435600_B2","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/PEC.0b013e318191db15","article-title":"The bruised premobile infant: should you evaluate further?","volume":"25","author":"Feldman","year":"2009","journal-title":"Pediatr Emerg Care"},{"issue":"7","key":"2021120907024435600_B3","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":"4","key":"2021120907024435600_B4","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1542\/peds.2012-2780","article-title":"Sentinel injuries in infants evaluated for child physical abuse.","volume":"131","author":"Sheets","year":"2013","journal-title":"Pediatrics"},{"issue":"1","key":"2021120907024435600_B5","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1177\/0009922812441675","article-title":"Facial bruising as a precursor to abusive head trauma.","volume":"52","author":"Petska","year":"2013","journal-title":"Clin Pediatr (Phila)"},{"key":"2021120907024435600_B6","unstructured":"Pierce MC, Kaczor K, Acker D, et al. 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