Background: Non-accidental Trauma (NAT) is a major cause of morbidity and mortality in children. Children less than 2 years old are at greater risk of NAT than older children. A skeletal survey is a series of X-rays of all the bones in the body, or at least the axial skeleton and the large cortical bones used to identify NAT in children. In this observational study, we examined the association between a child’s age, frequency of positive skeletal surveys, and the types of injuries discovered in pediatric patients undergoing a trauma work-up. Methods: The study sample consisted of all pediatric trauma patients ≤3 years old who had skeletal surveys performed at a single tertiary care center in Central Massachusetts between 2005 and 2015. Patients were divided into two age groups: ≤6months old (n=98) and >6months old (n=86). The utilization of a skeletal survey, frequency of confirmed NAT, and injuries were compared between these 2 age groups. Results: The average age of the sample was 8.4 months, 56.0% were boys, and 62.5% were Caucasian. A positive skeletal survey was found in 14.3% of patients ≤6months old and 18.6% of patients >6months old (p=0.43). The most common fractures identified were long bone (50.0%), torso (30.4%), and skull (13.0%). Similar frequencies of NAT were observed between those less than and older than 6 months (58.2% vs. 57.0%). Head computed tomography (CT) scans were performed in the majority (95.9%) of patients ≤6 months old while in only 66.3% of patients > 6 months old (p < 0.01). Conclusions: Skeletal surveys identify injuries at comparable rates in pediatric trauma patients regardless of age. Advanced imaging differs in younger and older pediatric trauma patients undergoing skeletal survey.

Introduktion: Barnmisshandel är ett problem som ökat senaste tiden och kan visa sig påolika sätt. Den fysiska barnmisshandeln innefattar ofta frakturer. För att kunna härleda frakturer till barnmisshandel behöver röntgensjuksköterskan ha kunskap om frakturernas utseende och dess placering. Syfte: Studiens syfte var att kartlägga frakturer och dess lokalisation som indikerar på fysisk barnmisshandel. Metod: Denna studie är en allmän litteraturöversikt. Utifrån syftet har tio artiklar analyserats och kategoriserats. Resultat: Studien kunde påvisa olika typer av frakturer som ofta var förekommande vid barnmisshandel. Dessa kategoriserades in i thorax, extremiteter, huvud och multipla frakturer. Det konstaterades bland annat att vänstersidiga frakturer, särskilt vid förekomst av revbensfrakturer, var överrepresenterade vid misshandel av barn under 18 månader. Små barn har dessutom högre risk att drabbas av skallfrakturer i samband med misshandel än äldre barn samt att de oftare har fler än en fraktur. Slutsats: Det finns frakturer som kan sättas mer i samband med barnmisshandel än andra. Genom ökad kunskap om dessa frakturer kan röntgensjuksköterskan lära sig att uppmärksamma dessa i tid och förhoppningsvis förhindra ytterligare misshandel av barnet. Om konventionell röntgen är rätt metod kan ifrågasättas då en datortomografi lättare kan upptäcka frakturerna. Det behöver dock vidare forskning av områden där det är svårt att avgöra om det rör sig om en fraktur eller inte. / Introduction: Child abuse is a problem that has increased recently and can manifest itself in different ways. Physical child abuse often involves fractures. To trace fractures related to child abuse, the radiographer needs to have knowledge of the appearance of the fractures and their location. Aim: The aim of the study was to map fractures and their location that indicates physical child abuse. Method: This study is a general literature review. Based on the purpose, ten articles have been analyzed and categorized. Results: The study was able to identify different types of fractures that were common in child abuse. These were categorized into thorax, extremities, head, and multiple fractures. It was found, among other things, that left-sided fractures, especially in the presence of rib fractures, were overrepresented in the abuse of children under 18 months. In addition, young children are at higher risk of suffering from skull fractures in connection with abuse than older children and that they more often have more than one fracture. Conclusion: There are fractures that can be associated more with child abuse than others. Through increased knowledge of these fractures, the radiographer can learn to pay attention to these in time and hopefully prevent further abuse of the child. Whether conventional X-ray is the right method can be questioned as a computed tomography scan can more easily detect the fractures. However, it needs further research of areas where it is difficult to determine whether it is a fracture or not.