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Babatunde J Akinpelu - One of the best experts on this subject based on the ideXlab platform.
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pediatric isolated thoracic and or lumbar transverse and spinous process fractures
Journal of Neurosurgery, 2016Co-Authors: Babatunde J Akinpelu, Scott L Zuckerman, Stephen R Gannon, Ashly C Westrick, Chevis N Shannon, Robert P NaftelAbstract:OBJECTIVE Isolated transverse and spinous process fractures (TPFx and SPFx) in the thoracic and/or lumbar region have been deemed clinically insignificant in the adult population. This same rule is often applied to the pediatric population; however, little evidence exists in this younger group. The goal of this study was to describe the clinical, radiographic, and long-term data on isolated TPFx and SPFx in an exclusively pediatric population. METHODS A retrospective chart review at Monroe Carell Jr. Children's Hospital at Vanderbilt University identified 82 pediatric patients with isolated TPFx and/or SPFx following a traumatic event between January 2000 and December 2013. Patient demographic information, presenting symptoms, radiographic characteristics, and follow-up data were collected. Follow-up was used to determine the outcome (presence of neurological deficits) of such injuries via complete physical examination and, when available, radiographic evidence. RESULTS In the 82 identified patients, the mean age was 15.5 ± 3.1 years (mean is expressed ± SD throughout), with 72 injuries (87.8%) resulting from a motor vehicle, motorcycle, or all-terrain vehicle accident. There was a mean of 1.7 ± 1.0 fractured vertebral levels involved and a mean of 1.8 ± 1.1 fractures was identified per patient. Seventy-one patients (86.6%) needed bedside pain control, 7 (8.5%) were prescribed a brace, and 4 patients (4.9%) received a collar. Physical therapy was recommended for 12 patients (14.6%). A total of 84.1% had follow-up, and the mean length of follow-up was 19 ± 37 months. No patients had true neurological deficits at presentation or follow-up as a result of their isolated fractures, whereas 95.1% had other associated system injuries. CONCLUSIONS These data shows that there is no appreciable long-term complication associated with isolated thoracic and/or lumbar TPFx and/or SPFx in an exclusively pediatric population. Because these fractures are, however, associated with high-energy blunt trauma, they often result in associated soft-tissue or other Skeletal Injury. All pediatric patients in the cohort benefited from conservative management and aggressive treatment of their comorbidities.
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pediatric isolated thoracic and or lumbar transverse and spinous process fractures
Journal of Neurosurgery, 2016Co-Authors: Babatunde J Akinpelu, Scott L Zuckerman, Stephen R Gannon, Ashly C Westrick, Chevis N Shannon, Robert P NaftelAbstract:OBJECTIVE Isolated transverse and spinous process fractures (TPFx and SPFx) in the thoracic and/or lumbar region have been deemed clinically insignificant in the adult population. This same rule is often applied to the pediatric population; however, little evidence exists in this younger group. The goal of this study was to describe the clinical, radiographic, and long-term data on isolated TPFx and SPFx in an exclusively pediatric population. METHODS A retrospective chart review at Monroe Carell Jr. Children's Hospital at Vanderbilt University identified 82 pediatric patients with isolated TPFx and/or SPFx following a traumatic event between January 2000 and December 2013. Patient demographic information, presenting symptoms, radiographic characteristics, and follow-up data were collected. Follow-up was used to determine the outcome (presence of neurological deficits) of such injuries via complete physical examination and, when available, radiographic evidence. RESULTS In the 82 identified patients, the mean age was 15.5 ± 3.1 years (mean is expressed ± SD throughout), with 72 injuries (87.8%) resulting from a motor vehicle, motorcycle, or all-terrain vehicle accident. There was a mean of 1.7 ± 1.0 fractured vertebral levels involved and a mean of 1.8 ± 1.1 fractures was identified per patient. Seventy-one patients (86.6%) needed bedside pain control, 7 (8.5%) were prescribed a brace, and 4 patients (4.9%) received a collar. Physical therapy was recommended for 12 patients (14.6%). A total of 84.1% had follow-up, and the mean length of follow-up was 19 ± 37 months. No patients had true neurological deficits at presentation or follow-up as a result of their isolated fractures, whereas 95.1% had other associated system injuries. CONCLUSIONS These data shows that there is no appreciable long-term complication associated with isolated thoracic and/or lumbar TPFx and/or SPFx in an exclusively pediatric population. Because these fractures are, however, associated with high-energy blunt trauma, they often result in associated soft-tissue or other Skeletal Injury. All pediatric patients in the cohort benefited from conservative management and aggressive treatment of their comorbidities.
Robert P Naftel - One of the best experts on this subject based on the ideXlab platform.
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pediatric isolated thoracic and or lumbar transverse and spinous process fractures
Journal of Neurosurgery, 2016Co-Authors: Babatunde J Akinpelu, Scott L Zuckerman, Stephen R Gannon, Ashly C Westrick, Chevis N Shannon, Robert P NaftelAbstract:OBJECTIVE Isolated transverse and spinous process fractures (TPFx and SPFx) in the thoracic and/or lumbar region have been deemed clinically insignificant in the adult population. This same rule is often applied to the pediatric population; however, little evidence exists in this younger group. The goal of this study was to describe the clinical, radiographic, and long-term data on isolated TPFx and SPFx in an exclusively pediatric population. METHODS A retrospective chart review at Monroe Carell Jr. Children's Hospital at Vanderbilt University identified 82 pediatric patients with isolated TPFx and/or SPFx following a traumatic event between January 2000 and December 2013. Patient demographic information, presenting symptoms, radiographic characteristics, and follow-up data were collected. Follow-up was used to determine the outcome (presence of neurological deficits) of such injuries via complete physical examination and, when available, radiographic evidence. RESULTS In the 82 identified patients, the mean age was 15.5 ± 3.1 years (mean is expressed ± SD throughout), with 72 injuries (87.8%) resulting from a motor vehicle, motorcycle, or all-terrain vehicle accident. There was a mean of 1.7 ± 1.0 fractured vertebral levels involved and a mean of 1.8 ± 1.1 fractures was identified per patient. Seventy-one patients (86.6%) needed bedside pain control, 7 (8.5%) were prescribed a brace, and 4 patients (4.9%) received a collar. Physical therapy was recommended for 12 patients (14.6%). A total of 84.1% had follow-up, and the mean length of follow-up was 19 ± 37 months. No patients had true neurological deficits at presentation or follow-up as a result of their isolated fractures, whereas 95.1% had other associated system injuries. CONCLUSIONS These data shows that there is no appreciable long-term complication associated with isolated thoracic and/or lumbar TPFx and/or SPFx in an exclusively pediatric population. Because these fractures are, however, associated with high-energy blunt trauma, they often result in associated soft-tissue or other Skeletal Injury. All pediatric patients in the cohort benefited from conservative management and aggressive treatment of their comorbidities.
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pediatric isolated thoracic and or lumbar transverse and spinous process fractures
Journal of Neurosurgery, 2016Co-Authors: Babatunde J Akinpelu, Scott L Zuckerman, Stephen R Gannon, Ashly C Westrick, Chevis N Shannon, Robert P NaftelAbstract:OBJECTIVE Isolated transverse and spinous process fractures (TPFx and SPFx) in the thoracic and/or lumbar region have been deemed clinically insignificant in the adult population. This same rule is often applied to the pediatric population; however, little evidence exists in this younger group. The goal of this study was to describe the clinical, radiographic, and long-term data on isolated TPFx and SPFx in an exclusively pediatric population. METHODS A retrospective chart review at Monroe Carell Jr. Children's Hospital at Vanderbilt University identified 82 pediatric patients with isolated TPFx and/or SPFx following a traumatic event between January 2000 and December 2013. Patient demographic information, presenting symptoms, radiographic characteristics, and follow-up data were collected. Follow-up was used to determine the outcome (presence of neurological deficits) of such injuries via complete physical examination and, when available, radiographic evidence. RESULTS In the 82 identified patients, the mean age was 15.5 ± 3.1 years (mean is expressed ± SD throughout), with 72 injuries (87.8%) resulting from a motor vehicle, motorcycle, or all-terrain vehicle accident. There was a mean of 1.7 ± 1.0 fractured vertebral levels involved and a mean of 1.8 ± 1.1 fractures was identified per patient. Seventy-one patients (86.6%) needed bedside pain control, 7 (8.5%) were prescribed a brace, and 4 patients (4.9%) received a collar. Physical therapy was recommended for 12 patients (14.6%). A total of 84.1% had follow-up, and the mean length of follow-up was 19 ± 37 months. No patients had true neurological deficits at presentation or follow-up as a result of their isolated fractures, whereas 95.1% had other associated system injuries. CONCLUSIONS These data shows that there is no appreciable long-term complication associated with isolated thoracic and/or lumbar TPFx and/or SPFx in an exclusively pediatric population. Because these fractures are, however, associated with high-energy blunt trauma, they often result in associated soft-tissue or other Skeletal Injury. All pediatric patients in the cohort benefited from conservative management and aggressive treatment of their comorbidities.
Brian D Blackbourne - One of the best experts on this subject based on the ideXlab platform.
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inflicted Skeletal Injury a postmortem radiologic histopathologic study in 31 infants
American Journal of Roentgenology, 1995Co-Authors: Paul K Kleinman, Sandy C Marks, Joann M Richmond, Brian D BlackbourneAbstract:The objective of this postmortem study was to use high-detail Skeletal surveys, specimen radiography, and histopathologic analysis to determine the number, distribution, and age of inflicted Skeletal injuries in infants studied at the University of Massachusetts Medical Center from 1984 to 1994.Thirty-one infants (average age, 3 months) who died with inflicted Skeletal injuries were studied with high-detail Skeletal surveys and specimen radiography and histopathologic analysis. The distribution and number of fractures was determined for each technique, and dating was performed on the basis of radiologic and histologic criteria. The skull fractures noted in 13 cases were excluded from the numerical analysis.The radiologic-histopathologic correlation revealed 165 fractures involving the ribs in 84 (51%), long bones in 72 (44%), bones of the hands and feet in 6 (4%), clavicles in 2 (1%), and spine in 1 (< 1%). Of the 72 long bone fractures, the metaphyses were involved in 64 (89%, or 39% of the total), and t...
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inflicted Skeletal Injury a postmortem radiologic histopathologic study in 31 infants
Society for Pediatric Radiology. Annual meeting, 1995Co-Authors: Paul K Kleinman, Sandy C Marks, Joann M Richmond, Brian D BlackbourneAbstract:OBJECTIVE. The objective of this postmortem study was to use high-detail Skeletal surveys, specimen radiography, and histopathologic analysis to determine the number, distribution, and age of inflicted Skeletal injuries in infants studied at the University of Massachusetts Medical Center from 1984 to 1994. MATERIALS AND METHODS. Thirty-one infants (average age, 3 months) who died with inflicted Skeletal injuries were studied with high-detail Skeletal surveys and specimen radiography and histopathologic analysis. The distribution and number of fractures was determined for each technique, and dating was performed on the basis of radiologic and histologic criteria. The skull fractures noted in 13 cases were excluded from the numerical analysis. RESULTS : The radiologic-histopathologic correlation revealed 165 fractures involving the ribs in 84 (51%), long bones in 72 (44%), bones of the hands and feet in 6 (4%), clavicles in 2 (1%), and spine in 1 (<1%). Of the 72 long bone fractures, the metaphyses were involved in 64 (89%, or 39% of the total), and the shaft was involved in 8 (11%, or 5% of the total). One hundred sixteen fractures were healing, 36 were acute, and 13 were of indeterminate age. In all but two infants, at least one healing fracture was present. Of fractures diagnosed histopathologically, specimen radiography increased the yield of fractures noted on Skeletal survey from 58% to 92%. CONCLUSION. Most infants who die with inflicted Injury have fractures at multiple sites. Metaphyseal and rib fractures are much more common than long bone shaft injuries, the opposite of the pattern found in older children. Because most abused infants who die have evidence of healing fractures at the time of autopsy, aggressive radiologic efforts to identify these injuries in living as well as in deceased infants appear justified.
Paul K Kleinman - One of the best experts on this subject based on the ideXlab platform.
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diagnostic imaging of child abuse
2015Co-Authors: Paul K KleinmanAbstract:I. Skeletal TRAUMA 1 The Structural and Developmental Contexts of Skeletal Injury 2 Skeletal Trauma: General Considerations 3 The Lower Extremity 4 The Upper Extremity 5 Bony Thoracic Trauma 6 Spinal Trauma 7 Dating Fractures 8 Differential Diagnosis I: Diseases Simulating Abuse 9 Differential Diagnosis II: Osteogenesis Imperfecta 10 Differential Diagnosis III: Accidental and Obstetrical Trauma 11 Differential Diagnosis IV: Normal Variants 12 Skeletal Imaging Strategies 13 Postmortem Imaging II. EXTRASkeletal TRAUMA AND MISCELLANEOUS CONDITIONS 14 Visceral Trauma 15 Head Trauma 16 Miscellaneous Forms of Abuse and Neglect III. DIAGNOSTIC IMAGING IN SOCIETAL CONTEXT 17 Psychosocial Considerations 18 Child Abuse and The Law I: General Issues for the Radiologist 19 Child Abuse and The Law II: The Radiologist in Court 20 The Radiologist's Response to Child Abuse IV. TECHNICAL CONSIDERATIONS AND DOSIMETRY 21 Imaging Technologies: Technological and Radiation Safety Considerations 22 Magnetic Resonance Imaging: Physical, Biological, and Clinical Principles 23 Quality Assurance and Skeletal Survey Standards
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inflicted Skeletal Injury a postmortem radiologic histopathologic study in 31 infants
American Journal of Roentgenology, 1995Co-Authors: Paul K Kleinman, Sandy C Marks, Joann M Richmond, Brian D BlackbourneAbstract:The objective of this postmortem study was to use high-detail Skeletal surveys, specimen radiography, and histopathologic analysis to determine the number, distribution, and age of inflicted Skeletal injuries in infants studied at the University of Massachusetts Medical Center from 1984 to 1994.Thirty-one infants (average age, 3 months) who died with inflicted Skeletal injuries were studied with high-detail Skeletal surveys and specimen radiography and histopathologic analysis. The distribution and number of fractures was determined for each technique, and dating was performed on the basis of radiologic and histologic criteria. The skull fractures noted in 13 cases were excluded from the numerical analysis.The radiologic-histopathologic correlation revealed 165 fractures involving the ribs in 84 (51%), long bones in 72 (44%), bones of the hands and feet in 6 (4%), clavicles in 2 (1%), and spine in 1 (< 1%). Of the 72 long bone fractures, the metaphyses were involved in 64 (89%, or 39% of the total), and t...
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inflicted Skeletal Injury a postmortem radiologic histopathologic study in 31 infants
Society for Pediatric Radiology. Annual meeting, 1995Co-Authors: Paul K Kleinman, Sandy C Marks, Joann M Richmond, Brian D BlackbourneAbstract:OBJECTIVE. The objective of this postmortem study was to use high-detail Skeletal surveys, specimen radiography, and histopathologic analysis to determine the number, distribution, and age of inflicted Skeletal injuries in infants studied at the University of Massachusetts Medical Center from 1984 to 1994. MATERIALS AND METHODS. Thirty-one infants (average age, 3 months) who died with inflicted Skeletal injuries were studied with high-detail Skeletal surveys and specimen radiography and histopathologic analysis. The distribution and number of fractures was determined for each technique, and dating was performed on the basis of radiologic and histologic criteria. The skull fractures noted in 13 cases were excluded from the numerical analysis. RESULTS : The radiologic-histopathologic correlation revealed 165 fractures involving the ribs in 84 (51%), long bones in 72 (44%), bones of the hands and feet in 6 (4%), clavicles in 2 (1%), and spine in 1 (<1%). Of the 72 long bone fractures, the metaphyses were involved in 64 (89%, or 39% of the total), and the shaft was involved in 8 (11%, or 5% of the total). One hundred sixteen fractures were healing, 36 were acute, and 13 were of indeterminate age. In all but two infants, at least one healing fracture was present. Of fractures diagnosed histopathologically, specimen radiography increased the yield of fractures noted on Skeletal survey from 58% to 92%. CONCLUSION. Most infants who die with inflicted Injury have fractures at multiple sites. Metaphyseal and rib fractures are much more common than long bone shaft injuries, the opposite of the pattern found in older children. Because most abused infants who die have evidence of healing fractures at the time of autopsy, aggressive radiologic efforts to identify these injuries in living as well as in deceased infants appear justified.
Flora Blangis - One of the best experts on this subject based on the ideXlab platform.
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add on bone scintigraphy after negative radiological Skeletal survey for the diagnosis of Skeletal Injury in children suspected of physical abuse a systematic review and meta analysis
Archives of Disease in Childhood, 2020Co-Authors: Flora Blangis, E Launay, Jeremie F Cohen, Melissa Taylor, Catherine Adamsbaum, Anne Devillers, Christele Grasle Guen, Patrick M M Bossuyt, Martin ChalumeauAbstract:Objective(s) To systematically assess the extent to which bone scintigraphy (BS) could improve the detection rate of Skeletal Injury in children suspected of physical abuse with an initial negative radiological Skeletal survey (RSS). Study design We searched MEDLINE and Web of Science for series of ≥20 children suspected of physical abuse who underwent RSS and add-on BS. We assessed the risk of bias and the heterogeneity and performed random-effects meta-analyses. Results After screening 1140 unique search results, we reviewed 51 full-text articles, and included 7 studies (783 children, mostly ≤3 years old). All studies were of either high or unclear risk of bias. Substantial heterogeneity was observed in meta-analyses. The summary detection rate of Skeletal Injury with RSS alone was 52% (95% CI 37 to 68). The summary absolute increase in detection rate with add-on BS was 10 percentage points (95% CI 6 to 15); the summary relative detection rate was 1.19 (95% CI 1.13 to 1.25); the summary number of children with a negative RSS who needed to undergo a BS to detect one additional child with Skeletal Injury (number needed to test) was 3 (95% CI 2 to 7). Conclusions From the available evidence, add-on BS in young children suspected of physical abuse with a negative RSS might allow for a clinically significant improvement of the detection rate of children with Skeletal Injury, for a limited number of BS procedures required. The quality of the reviewed evidence was low, pointing to the need for high-quality studies in this field.
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bone scintigraphy after a negative radiological Skeletal survey improves the detection rate of inflicted Skeletal Injury in children
Frontiers in Pediatrics, 2020Co-Authors: Flora Blangis, Cyrielle Poullaouec, E Launay, N Vabres, Flavie Sadones, Thomas Eugene, Jeremie F CohenAbstract:Background: Timely diagnosis of child physical abuse is of paramount importance. The added value of bone scintigraphy (BS) after a negative radiological Skeletal survey (RSS) in children with suspected physical abuse has never been evaluated. Objective: The objective of this study was to assess the extent to which BS could improve the detection rate of Skeletal Injury in children with suspected physical abuse with an initial negative RSS. Methods: We used discharge codes to retrospectively identify children evaluated for suspected physical abuse in a university hospital (Nantes, France). We included all consecutive children younger than 3 years old who underwent both RSS and BS, with an interval of ≤96 h between tests, from 2013 to 2019. BS and RSS results were interpreted independently during the study period. We specifically analyzed BS results for children with a negative RSS to assess the value of BS as an add-on test. Results: Among the 268 children ≤3 years old with suspected physical abuse who underwent RSS, 140 (52%) also underwent BS within 96 h and were included in the analysis. The median age was 6 months old (interquartile range: 3-8). The detection rate of ≥1 Skeletal Injury with RSS alone was 49% (n = 69/140, 95% CI: 41-58%) vs. 58% (n = 81/140, 50-66%) with RSS followed by add-on BS, for an absolute increase in the detection rate of 9% points (95% CI: 4-14%). The number of children with a negative RSS who would need to undergo BS to detect one additional child with ≥1 Skeletal Injury was 6 (95% CI: 4-11). Conclusion: In young children with suspected physical abuse with a negative RSS, add-on BS would allow for a clinically significant improvement in the detection rate of Skeletal injuries for a limited number of BS procedures required. Prospective multicenter studies are needed to confirm these findings.