Post-mortem skeletal surveys in suspected non-accidental injury.

AIM: To evaluate potential differences between live (LSS) and post-mortem skeletal surveys (PMSS) in cases of non-accidental injury (NAI).

MATERIALS AND

METHODS

All skeletal surveys (SS) performed for suspected NAI over a 5 year period were retrospectively reviewed. Demographic details, injuries obtained, artefacts, and radiographic difficulties encountered during LSS and PMSS were recorded.

RESULTS

Of 195 surveys performed, there were significantly fewer positive PMSS (11/128; 8.6%) than LSS (16/67; 23.8%), but no difference between the actual injuries encountered. Of those who had a positive SS, dead children were significantly younger (mean age 2.6 ± 3.4 months old) than live children (7.8 ± 6.9 months old; p < 0.05). Thirty-six percent of all contemporary digital radiographs contained artefacts, particularly in PMSS (599/1504; 39.8%) compared to LSS (269/904: 29.7%; p < 0.001), which were mostly patient identification labels (55.1 versus 21.6%; p < 0.001). PMSS demonstrated death-related radiographic complications in 10.6% of cases.

CONCLUSION

Radiographic imaging in deceased children is not easy, and yields significant artefacts, which may hamper image interpretation. A technique for obtaining multiple views of a limb in fixed flexion deformity to maximize the diagnostic potential is described. Careful consideration of these factors would maximize the diagnostic yield in this unique patient population.