Prevalence and relevance of pediatric spinal fractures in suspected child abuse

Background Spinal fractures are uncommon manifestations of child abuse and elimination of the lateral views of the spine from the initial skeletal survey protocol has been recommended. Objective To establish the prevalence of spinal fractures detected on skeletal surveys performed for suspected child abuse and their association with intracranial injury (ICI). Materials and methods The ACR standardized skeletal surveys and neuroimaging studies of 751 children (ages 0–4 years) were reviewed. A positive skeletal survey was defined as having one or more clinically unsuspected fractures. Results Fourteen children had a total of 22 definite spinal fractures. This constituted 1.9% (14/751) of the total cohort, and 9.7% (14/145) of children with a positive skeletal survey. Advanced imaging confirmed the fractures in 13 of the 14 children and demonstrated 12 additional spinal fractures. In five cases, spinal fractures were the only positive skeletal findings. In 71% (10/14) of the children, the spinal fractures were accompanied by ICI. Children with spinal fractures were at significantly greater risk for ICI than those without spinal injury ( P < 0.05). Conclusion Spinal fractures are not rare in children with positive skeletal surveys performed for suspected abuse and they may be the only indication of skeletal trauma. There is an association between spinal fractures and ICI.