G87. FREQUENCY OF OCCULT SKELETAL AND NEUROLOGICAL INJURIES IN CHILDREN UNDERGOING A SKELETAL SURVEY FOR SUSPECTED NON ACCIDENTAL INJURY

L.J. Fender, N. Broderick, J. Somers, T. Jaspan, N. McConchie, K.H. Halliday.

Queen’s Medical Centre, Nottingham

Aims: To determine the detection rate of occult fractures in patients undergoing a skeletal survey for suspected NAI, the value of routine neurological imaging and the impact of follow up radiographs.

Materials and Methods: Skeletal Surveys of 100 consecutive patients with suspected NAI were retrospectively reviewed. The routine follow up chest X-ray performed at 10 to 14 days was reviewed to assess the detection of further rib fractures not evident on the initial film and to determine if further information to aid the dating of rib fractures became apparent. The findings of neurological imaging were correlated with clinical indicators of intracranial injury.

Results: Clinically unsuspected fractures were detected in 34 patients. Of the 100 patients follow up chest radiographs were performed in 29 patients. In 3 cases (14%) further useful information about dating was obtained and in 1 case rib fractures not visible on the initial film were revealed. 31 pts had an intracranial abnormality demonstrated on cranial Computed Tomography. 23% (7 patients) of these had no neurological symptoms or signs. Of 16 patients with no skeletal fractures or clinical features suggesting neurological injury, 1 had a subdural haematomata of differing ages highly suggestive of abuse.

Conclusions: Occult injuries were detected in 34%. Routine cranial imaging is advocated to detect occult intracranial injuries, which maybe the only radiological manifestation of Non Accidental Injury. The follow up chest radiograph did not alter the diagnosis in any patient but was helpful in 14% of cases.

G88. INTERNAL ABDOMINAL INJURY DUE TO CHILD ABUSE—FINDINGS OF THE FIRST YEAR OF A BPSU STUDY

P.M. Barnes, J.R. Sibert, C.A. Norton, A.M. Kemp.

Department of Community Child Health, Llandough Hospital, Cardiff

Introduction: Internal abdominal injury is a recognised consequence of physical child abuse, but there is little published literature concerning this condition. The paediatrician may face …