SPA in children

Question 1

suspect PA IF:
no history
inconsistent/inappropriate
conflicting history
delay in presentation
multiple injuries, different ages, locations

Question 2

what does NAI stand for

Answer 2

non-accidental injury

Question 3

abused kids with visceral injury present later in time

6-55% NAI are sufficient to cause fracture

fractures are 2nd most common finding in child abuse, whats first

Answer 3

cutaneous findings (skin injuries)

Question 4

whats the main cause of morbidity and mortality in NAI

Answer 4

intracranial injuries

Question 5

how does the type of imaging required in SPA case differ by age

Answer 5

less than 2 = skeletal survey
less than 1 = skeletal survey + CT HEAD

children older than 1 only need CT head with evidence of head trauma/neurology

Question 6

REMEMBER, where any case of SPA, siblings of victim less than 2 (even if results are negative) must also be imaged

Question 7

a skeletal survey must be acquired and reported done within what time frame, who must be present to conduct

Answer 7

within 24 hours but no later than 72
(performed 9-5, mon to Friday only)

2 trained PAEDIATRIC radiographers needed (can be registered paediatric nurse OR registered nurse with paediatric training) (CANNOT be HCA or student as unqualified)

• sedation may be needed

Question 8

up to 32 radiographs taken in initial SS (dependant on child size) and 11 FOLLOW UPS

• additional lateral and coned views and follow up long bone views added to increase pick up of fractures

Question 9

how long after should follow up imaging ideally take

Answer 9

11-14 days. (no longer than 28)

• robust procedures in like to ensure patients return
• named professional should be identified

Question 10

why would you do a follow up xray?

Answer 10

delayed appearance of injuries

Question 11

what type of CT imaging for under 1 in SPA is performed, if positive result, what imaging is done next and within what time frame

Answer 11

unenhanced CT with multiplayer reformat

• if positive, do MR head and spine within 2-6 days (reported by appropriately trained neuroradiologist)

Question 12

what does SIDS stand fro

Answer 12

sudden infant death syndrome

Question 13

post mortem imaging of whole body is indicated in cases of SIDS.

If theres diagnostic doubt on SS, what imaging is performed

Answer 13

WHOLE BODY CT/MR

Question 14

check iPad images to see areas of high and low occurring fracture locations

Question 15

what type of physical motion causes metaphysical fractures on kids

Answer 15

shaking, gripping, twisting, pulling (know what a metaphysical injury looks like on kids)

Question 16

what does SPNBF stand for and what mechanism of injury causes this

Answer 16

subperiosteal new bone formation

gripping (know what this looks like)

Question 17

what mechanism causes transverse fracture sin kids

Answer 17

direct blows/ applied level force

Question 18

what mechanism causes spiral fracture sin kids

Answer 18

twisting

Question 19

what mechanism causes fracture separation sin kids

Answer 19

pulling

Question 20

REMEMBER: if kids get pushed really hard or squeezed around their chest really hard, it can cause multiple areas of fractures around the ring of rib (look at iPad image if u dont understand)

Question 21

what is a non-ambulating child

Answer 21

A child who is not walking by 18 to 20 months is considered to be delayed in ambulation.

Question 22

what does ASD stand for

Answer 22

autism spectral disease

Question 23

note: you must know how to tell the differenc between incidental and inflicted injuries e.g if the kid has multiple fractures could be be that they have a disorder causing their bones to be brittle? if not, this may be abuse.

check previous involvement by CPS etc

(check Ipade images for more comparisons)