Computed tomography versus radiography for the detection of rib and skull fractures in paediatric suspected physical abuse: a systematic review

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Date
2024
Authors
Mohammed, Ahmed
Mahon, Eimear
Moore, Niamh
Sweetman, Lorna
Maher, Michael M.
O’Regan, Patrick
England, Andrew
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Springer Nature
Published Version
https://doi.org/10.1007/s00431-024-05894-9
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Abstract
The diagnosis of suspected physical abuse (SPA) remains a continuous challenge to paediatric healthcare. Several studies have reported that computed tomography (CT) improves the evaluation of SPA. This study aims to systematically review the diagnostic performance of CT compared to radiography in investigating skull and chest fractures for SPA. Multiple databases were searched, using PRISMA methods, from 2008 to August 2024 for relevant studies in English. Two reviewers independently screened and selected relevant studies using Covidence software. The QUADAS-2 tool was used for the quality assessment of the included papers. Sensitivity, specificity and the effective radiation dose of CT and radiography from the included studies were extracted. Pooled sensitivity and specificity were calculated with their respective 95% confidence intervals (CI). GRADE criteria were used to appraise the overall quality of the synthesis. Of the 4057 identified papers, 10 met the inclusion criteria; all 10 included skull and/or chest. The overall sensitivity and specificity of CT were 96.5% (95% CI, 94.9-97.7%) and 99.5% (95% CI, 99.1-99.8%), respectively. Compared to the sensitivity and specificity of radiography, 59.8% (95% CI, 56.2-63.3%) and 99.7% (95% CI, 99.3-99.8%), respectively. Conclusion: CT sensitivity is significantly higher than radiography in detecting rib and skull fractures for SPA. The effective dose for chest LDCT is comparable to that of radiography. Therefore, LDCT should be considered a potential replacement to radiography in SPA investigations for the chest and skull. What is Known • CT shows higher diagnostic performance than radiography in detecting skull and rib fractures in the diagnosis of SPA. What is New • When a head CT scan is acquired for SPA diagnosis at any age, the two-view skull radiograph can be safely eliminated from the Skeletal Survey protocol, likewise, Chest CT can replace chest radiography for SPA diagnosis of rib fractures. • The effective dose and image quality of low-dose chest CT is comparable to that of two-view chest radiography for SPA diagnosis.
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Keywords
Chest , Diagnosis , Head , Non-accidental injury , Skeletal survey
Citation
Mohammed, A., Mahon, E., Moore, N., Sweetman, L., Maher, M., O’Regan, P., England, A. and McEntee, M.F. (2024) ‘Computed tomography versus radiography for the detection of rib and skull fractures in paediatric suspected physical abuse: a systematic review’, European Journal of Pediatrics, 184(1), 69. https://doi.org/10.1007/s00431-024-05894-9
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https://hdl.handle.net/10468/16723
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Medicine - Journal Articles
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© 2024, the Authors, under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s00431-024-05894-9