Table_3_Bone Scintigraphy After a Negative Radiological Skeletal Survey Improves the Detection Rate of Inflicted Skeletal Injury in Children.docx

Background: Timely diagnosis of child physical abuse is of paramount importance. The added value of bone scintigraphy (BS) after a negative radiological skeletal survey (RSS) in children with suspected physical abuse has never been evaluated.Objective: The objective of this study was to assess the extent to which BS could improve the detection rate of skeletal injury in children with suspected physical abuse with an initial negative RSS.Methods: We used discharge codes to retrospectively identify children evaluated for suspected physical abuse in a university hospital (Nantes, France). We included all consecutive children younger than 3 years old who underwent both RSS and BS, with an interval of ≤96 h between tests, from 2013 to 2019. BS and RSS results were interpreted independently during the study period. We specifically analyzed BS results for children with a negative RSS to assess the value of BS as an add-on test.Results: Among the 268 children ≤3 years old with suspected physical abuse who underwent RSS, 140 (52%) also underwent BS within 96 h and were included in the analysis. The median age was 6 months old (interquartile range: 3–8). The detection rate of ≥1 skeletal injury with RSS alone was 49% (n = 69/140, 95% CI: 41–58%) vs. 58% (n = 81/140, 50–66%) with RSS followed by add-on BS, for an absolute increase in the detection rate of 9% points (95% CI: 4–14%). The number of children with a negative RSS who would need to undergo BS to detect one additional child with ≥1 skeletal injury was 6 (95% CI: 4–11).Conclusion: In young children with suspected physical abuse with a negative RSS, add-on BS would allow for a clinically significant improvement in the detection rate of skeletal injuries for a limited number of BS procedures required. Prospective multicenter studies are needed to confirm these findings.

背景：对疑似儿童身体虐待的及时诊断至关重要。在疑似身体虐待的儿童进行初步的放射性骨骼扫描（RSS）结果为阴性后，骨显像（BS）的附加价值从未得到评估。目的：本研究旨在评估骨显像（BS）在疑似身体虐待的儿童中，经初步的放射性骨骼扫描（RSS）结果为阴性后，能改善骨骼损伤检测率的程度。方法：我们利用出院编码，回顾性地识别了法国南特大学医院（Nantes, France）中接受疑似身体虐待评估的儿童。我们纳入了所有在2013年至2019年期间，年龄小于3岁、在≤96小时测试间隔内同时接受RSS和BS检查的连续儿童。在研究期间，对BS和RSS结果进行了独立解读。我们特别分析了RSS结果为阴性的儿童的BS结果，以评估BS作为附加检测的价值。结果：在接受了RSS的268名≤3岁的疑似身体虐待儿童中，有140名（52%）在96小时内也接受了BS，并被纳入分析。中位年龄为6个月（四分位数范围：3–8）。仅使用RSS检测≥1处骨骼损伤的检测率为49%（n = 69/140，95% CI: 41–58%），而在RSS后附加BS检测的检测率为58%（n = 81/140，95% CI: 50–66%），检测率绝对提高9个百分点（95% CI: 4–14%）。需要接受BS以检测一名额外≥1处骨骼损伤的儿童数量为6（95% CI: 4–11）。结论：对于RSS结果为阴性的疑似身体虐待的幼童，附加BS检测将允许在有限的BS检测次数下，显著提高骨骼损伤的检测率。需要进行前瞻性多中心研究以证实这些发现。