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M R Ditchfield - One of the best experts on this subject based on the ideXlab platform.
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complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse
Archives of Disease in Childhood, 2003Co-Authors: Simone Mandelstam, D Cook, M Fitzgerald, M R DitchfieldAbstract:Aim: To compare the effectiveness of radiological skeletal survey and bone scintigraphy for the detection of bony injuries in cases of suspected child abuse. Methods: All cases with a discharge diagnosis of child abuse that presented to the Royal Children's Hospital between 1989 and 1998 were retrieved, and those children that had undergone both skeletal survey and bone scintigraphy (radioisotope bone scan) within a 48 hour period were included in this study. Both examinations followed rigid departmental protocols and protocols remained identical throughout the timeframe of the study. The reports of the skeletal surveys and bone scans were retrospectively reviewed by a paediatric radiology fellow and consultant paediatric radiologist. Results: The total number of bony injuries identified was 124 in 30 children. Of these, 64 were identified on bone scan and 77 on skeletal survey. Rib fractures represented 60/124 (48%) of the bony injuries and were present in 16/30 children (53%), of which 62.5% had multiple rib fractures. Excluding rib fractures, there were 64 (52%) bony injuries, of which 33% were seen on both imaging modalities, 44% were seen on skeletal survey only, and 25% were seen on bone scans alone. Metaphyseal lesions typical of child abuse were present in 20 cases (31%) on skeletal survey; only 35% of these were identified on bone scan. Six children (20%) had normal skeletal surveys, with abnormalities shown on bone scan. There were three children (10%) with normal bone scans who were shown to have injuries radiographically. Conclusions: Skeletal survey and bone scintigraphy are complementary studies in the evaluation of Non-Accidental Injury, and should both be performed in cases of suspected child abuse.
Amaka C. Offiah - One of the best experts on this subject based on the ideXlab platform.
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imaging and reporting considerations for suspected physical abuse non accidental Injury in infants and young children part 1 initial considerations and appendicular skeleton
Clinical Radiology, 2017Co-Authors: Michael Paddock, A Sprigg, Amaka C. OffiahAbstract:Recognising the skeletal manifestations of inflicted Injury (II) in infants and young children is of crucial importance. There are specific fracture patterns which are highly suspicious of II in addition to common differential diagnoses with which radiologists should be familiar. Our objective is to provide a non-exhaustive review of the important factors relevant to the imaging and reporting of II as a platform for further learning. Part 1 encompasses important initial considerations and fracture patterns of the appendicular skeleton.
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imaging and reporting considerations for suspected physical abuse non accidental Injury in infants and young children part 2 axial skeleton and differential diagnoses
Clinical Radiology, 2017Co-Authors: Michael Paddock, A Sprigg, Amaka C. OffiahAbstract:Recognising the skeletal manifestations of inflicted Injury (II) in infants and young children is of crucial importance. There are specific fracture patterns which are highly suspicious of II in addition to common differential diagnoses with which radiologists should be familiar. Our objective is to provide a non-exhaustive review of the important factors relevant to the imaging and reporting of II as a platform for further learning. Part 2 encompasses fracture patterns of the axial skeleton and important differential diagnoses.
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espr adopts british guidelines for imaging in suspected non accidental Injury as the european standard
Pediatric Radiology, 2014Co-Authors: Amaka C. Offiah, Catherine Adamsbaum, Rick R. Van RijnAbstract:National surveys conducted over the last decade [1–3]havehighlighted inconsistenciesamong departmentsasregardstheprojections and quality of images obtained when child abuseissuspected.Haspublicationoftheresultsofthesesurveysledto any improvement? We would like to think so, and while afollow-up UK audit demonstrated only a modest increase inadherence to the then-British Society of Paediatric Radiologyguidelines [4], anecdotally we believe that the quality ofskeletal surveys and therefore the accuracy and speed ofdiagnosis in these cases has significantly improved.However, rather than repeating national surveys, under theleadership of Rick van Rijn (ex-chairperson of the ESPR(European Society of Paediatric Radiology) Child AbuseTaskforce), a Europe-wide survey of ESPR members wasundertaken. The linked article in this edition of PediatricRadiology [5] presents the findings.Here, we would like to emphasize the key outcome thatfollowed presentation of the results by Amaka Offiah to theChildAbuseTaskforceduringtheESPRmeetinginBudapest,Hungary, in June 2013, namely an overwhelming vote infavor of adopting the Royal College of Radiologists/RoyalCollege of Paediatrics and Child Health (RCR/RCPCH)Guidelines for Imaging in Suspected Non-Accidental Injury[6] as the standard across Europe. We believe this will lead toimproved detection of abuse in children and to more robustsafeguarding protocols, and it is with great pleasure that weannouncethattheESPRcommitteehasratifiedthismove.Theguidelines are available at http://www.rcr.ac.uk/docs/radiology/pdf/RCPCH_RCR_final.pdf.We are in the process of translating these guidelines intoother major European languages, and would ask you, in yourvarious countries and beyond, to please spread the word.
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European survey of imaging in Non-Accidental Injury demonstrates a need for a consensus protocol.
Pediatric radiology, 2014Co-Authors: Oliver Hulson, Rick R. Van Rijn, Amaka C. OffiahAbstract:Paediatric Non-Accidental Injury is a considerable health problem, and imaging plays a fundamental role in its assessment. Since the introduction of joint guidelines published by the Royal College of Radiologists (RCR) and Royal College of Paediatrics and Child Health (RCPCH) in 2008, there has been a concerted effort to adopt a consensus approach to imaging in this area in the United Kingdom. This study aims to establish current practice amongst European Society of Paediatric Radiology (ESPR) members within their institutions with regards to the use of imaging in suspected Non-Accidental Injury. A web-based survey was created and circulated to all active ESPR members. The responses were collated and analysed. We received 134 responses, accounting for 37% of the current membership across 24 European countries. These responses highlighted significant variation amongst institutions, with no consensus regarding radiographic and cross-sectional imaging in the investigation of suspected Non-Accidental Injury. There is a need for a European consensus protocol to imaging in suspected Non-Accidental Injury. We recommend implementing the joint RCR/RCPCH guidance, a move supported by the ESPR.
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diagnostic accuracy of fracture detection in suspected non accidental Injury the effect of edge enhancement and digital display on observer performance
Clinical Radiology, 2006Co-Authors: Amaka C. Offiah, Christine Hall, L Moon, Andrew ToddpokropekAbstract:AIM To compare the effect of varying degrees of edge enhancement and method of digital image display on fracture detection in suspected Non-Accidental Injury (NAI). MATERIALS AND METHODS Fifty radiographs from post-mortem skeletal surveys in 13 children with suspected NAI were selected. Images were obtained using a Fuji 5000R computed radiography system. Hard copies were printed with edge enhancement factors 0, 0.5 and 1.2. Images (edge enhancement 0.5) were also displayed on a 1K2 monitor. Six observers independently evaluated all 200 images for the presence of abnormality. Observers also scored each image for visualization of soft tissues, visualization of trabecular markings and overall image quality. The paired Student's t-test and location receiver operating curve (ROC) analysis were used to compare quality scores and diagnostic accuracy of each display method. Individual and pooled true-positive rates (sensitivity) were determined. For the purposes of ROC analysis, histology was taken as the gold standard. RESULTS There was no difference in duration of hard and soft-copy reading sessions (p=0.76). After image manipulation soft-copy radiographs scored significantly better for image quality than hard copy (p CONCLUSION In suspected NAI, diagnostic accuracy of fracture detection is generally low. Diagnostic accuracy appears to be affected more by observer-related factors than by the method of digital image display.
Simone Mandelstam - One of the best experts on this subject based on the ideXlab platform.
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complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse
Archives of Disease in Childhood, 2003Co-Authors: Simone Mandelstam, D Cook, M Fitzgerald, M R DitchfieldAbstract:Aim: To compare the effectiveness of radiological skeletal survey and bone scintigraphy for the detection of bony injuries in cases of suspected child abuse. Methods: All cases with a discharge diagnosis of child abuse that presented to the Royal Children's Hospital between 1989 and 1998 were retrieved, and those children that had undergone both skeletal survey and bone scintigraphy (radioisotope bone scan) within a 48 hour period were included in this study. Both examinations followed rigid departmental protocols and protocols remained identical throughout the timeframe of the study. The reports of the skeletal surveys and bone scans were retrospectively reviewed by a paediatric radiology fellow and consultant paediatric radiologist. Results: The total number of bony injuries identified was 124 in 30 children. Of these, 64 were identified on bone scan and 77 on skeletal survey. Rib fractures represented 60/124 (48%) of the bony injuries and were present in 16/30 children (53%), of which 62.5% had multiple rib fractures. Excluding rib fractures, there were 64 (52%) bony injuries, of which 33% were seen on both imaging modalities, 44% were seen on skeletal survey only, and 25% were seen on bone scans alone. Metaphyseal lesions typical of child abuse were present in 20 cases (31%) on skeletal survey; only 35% of these were identified on bone scan. Six children (20%) had normal skeletal surveys, with abnormalities shown on bone scan. There were three children (10%) with normal bone scans who were shown to have injuries radiographically. Conclusions: Skeletal survey and bone scintigraphy are complementary studies in the evaluation of Non-Accidental Injury, and should both be performed in cases of suspected child abuse.
M A Parsons - One of the best experts on this subject based on the ideXlab platform.
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the ophthalmic pathology cut up part 1 the enucleation and exenteration specimen
Current Diagnostic Pathology, 2005Co-Authors: A L Ford, Hardeep Singh Mudhar, R Farr, M A ParsonsAbstract:Summary This is the first of two articles designed to facilitate the approach to cutting up ophthalmic pathology specimens. This article deals with the enucleation and orbital exenteration specimen. Ophthalmologists would have made a detailed examination of the eye in vivo with a slit-lamp microscope and imaging modalities. As such, they will expect high-quality pathology feedback to complete the clinicopathological loop. Both tumour and non-tumour pathology cases are discussed. This protocol should not be used for post-mortem enucleations in the setting of suspected Non-Accidental Injury. The text does assume some basic knowledge of clinical ophthalmology terminology.
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ocular and cerebral trauma in non accidental Injury in infancy underlying mechanisms and implications for paediatric practice
British Journal of Ophthalmology, 1996Co-Authors: M A Green, G Lieberman, C M Milroy, M A ParsonsAbstract:AIMS: To determine the sites, mechanisms, and clinical significance of injuries to the eyes and brains of children with Non-Accidental injuries in relation to differing levels of trauma. METHODS: A forensic pathological study of injuries in the eyes and brains of 23 consecutive children dying of Non-Accidental injuries over a 4 year period (1988-92) under the jurisdiction of Yorkshire and Humberside coroners. RESULTS: Sixteen children died from cerebral injuries and seven died from non-cerebral causes. There were high incidences of retinal detachment (63%) and subhyaloid (75%), intraretinal (75%), and perineural (68%) haemorrhages in CNS deaths. Local subhyaloid haemorrhages and retinal detachment were more common at the periphery and optic disc than at the equator. There was a strong correlation between CNS and eye trauma scores in all 23 children (r = 0.7551, p < 0.0001). Ranking of injuries by severity suggests progressively more trauma required for (a) subdural haemorrhage, (b) subhyaloid, intraretinal, perineural haemorrhages, and (c) retinal detachment. At highest trauma levels choroidal and vitreous haemorrhages were associated with additional cerebral lacerations, intracerebral and subarachnoid haemorrhages. CONCLUSIONS: In Non-Accidental (and probably accidental) infantile head Injury the earliest eye injuries (coinciding with subdural haemorrhage) could be missed if indirect ophthalmoscopy is not performed. Retinal detachment and multiple (particularly choroidal/vitreous) haemorrhages may indicate additional cerebral lacerations and/or intracerebral haemorrhage. Vitreous traction is the likely cause of intraocular pathology.
K W Kemp - One of the best experts on this subject based on the ideXlab platform.
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apnoea and brain swelling in non accidental head Injury
Archives of Disease in Childhood, 2003Co-Authors: Alison Mary Kemp, Neil Stoodley, C Cobley, L Coles, K W KempAbstract:Aims: (1) To identify whether infants and young children admitted to hospital with subdural haematomas (SDH) secondary to Non-Accidental head Injury (NAHI), suffer from apnoea leading to radiological evidence of hypoxic ischaemic brain damage, and whether this is related to a poor prognosis; and (2) to determine what degree of trauma is associated with NAHI. Methods: Retrospective case series (1992–98) with case control analysis of 65 children under 2 years old, with an SDH secondary to NAHI. Outcome measures were presenting symptoms, associated injuries and apnoea at presentation, brain swelling or hypoxic ischaemic changes on neuroimaging, and clinical outcome (KOSCHI). Results: Twenty two children had a history of apnoea at presentation to hospital. Apnoea was significantly associated with hypoxic ischaemic brain damage. Severe symptoms at presentation, apnoea, and diffuse brain swelling/hypoxic ischaemic damage were significantly associated with a poor prognosis. Eighty five per cent of cases had associated injuries consistent with a diagnosis of Non-Accidental Injury. Conclusions: Coma at presentation, apnoea, and diffuse brain swelling or hypoxic ischaemia all predict a poor outcome in an infant who has suffered from SDH after NAHI. There is evidence of associated violence in the majority of infants with NAHI. At this point in time we do not know the minimum forces necessary to cause NAHI. It is clear however that it is never acceptable to shake a baby.