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Oblique chest views as a routine part of skeletal surveys performed for possible physical abuse--is this practice worthwhile?
[child syndrome]
To
evaluate
the
utility
of
oblique
chest
views
in
the
diagnosis
of
rib
fractures
when
used
as
a
routine
part
of
the
skeletal
survey
performed
for
possible
physical
abuse
.
Oblique
chest
views
have
been
part
of
the
routine
skeletal
survey
protocol
at
Primary
Children
's
Medical
Center
since
October
2002
.
Dictated
radiology
reports
since
that
time
were
reviewed
,
and
all
cases
with
rib
fractures
documented
were
chosen
for
study
.
For
each
chosen
case
two
pediatric
radiologists
identified
and
recorded
rib
fractures
using
only
the
PA
and
lateral
chest
radiographs
(
standard
two
-view
chest
series
)
from
the
skeletal
survey
for
each
case
.
In
a
separate
session
they
identified
and
recorded
rib
fractures
using
the
PA
,
lateral
,
right
oblique
,
and
left
oblique
radiographs
(
four
-view
chest
series
)
from
the
skeletal
survey
for
each
case
.
The
results
were
compared
.
Twenty
-
two
cases
with
rib
fractures
were
identified
.
Interpretation
of
the
four
-view
chest
series
was
different
than
interpretation
of
the
two
-view
chest
series
in
12
of
the
22
cases
(
54
%
)
.
Overall
,
the
four
-view
chest
series
differed
significantly
in
the
number
of
rib
fractures
diagnosed
compared
with
the
two
-view
chest
series
(
p
=
.
02
,
Wilcoxon
matched-pairs
signed-rank
test
)
adding
19
rib
fractures
and
excluding
6
rib
fractures
.
The
results
indicate
that
use
of
the
four
-view
chest
series
adds
information
to
that
obtained
from
the
two
-view
chest
series
and
increases
the
accuracy
of
diagnosing
rib
fractures
in
cases
of
possible
physical
abuse
.
Addition
of
oblique
chest
views
to
the
routine
protocol
for
skeletal
surveys
performed
for
possible
physical
abuse
is
recommended
.
Diseases
Validation
Diseases presenting
"skeletal survey"
symptom
child syndrome
dentinogenesis imperfecta
monosomy 21
proteus syndrome
werner syndrome
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