Comparison of radiography and radionuclide bone scanning in the detection of child abuse.

The battered child syndrome consists of a constellation of signs that may be either apparent or covert. Radiographic documentation of unexplained or difficult-to-detect fractures is an important means of establishing a basis for legal intervention in child abuse. One hundred ten children were evaluated with either radiographic surveys or bone scans, and 50 children had both roentgenograms and bone scans. In 40% of the children there was at least one fracture whereas 20% had between two and seven fractures. Among the children who received both skeletal surveys and bone scans, 41 fractures were detected: skeletal survey detected 52% and bone scan detected 88% of those fractures. Children with fractures were more likely to be placed in foster homes than to be returned to the original environment. The presence of single v multiple fractures did not alter the probability of foster placement. It was concluded that fracture documentation is important in determining whether to place abused children in foster homes. Both skeletal surveys and radionuclide bone scanning had high false-negative values. When either test is initially negative and blatant signs of physical abuse are present, both tests should be performed to ensure the greatest probability of fracture detection.