Physical Abuse Clinical Pathway, Emergency Department, Outpatient Specialty Care and Primary Care – Skeletal Survey Recommendations

Indications and Exceptions for Obtaining a Skeletal Survey

Age	Indications for Skeletal Survey
0-23 mos	History of: Confessed abuse Injury occurring during domestic violence Impact from toy/object causing fracture Delay in seeking care > 24 hrs in child with signs of distress Additional injuries unrelated to fracture i.e., bruising, burns No History of trauma to explain fracture Exceptions Presence of these fracture types in ambulatory patients > 12 mos if no clinical concerns: Distal buckle fracture of radius/ulna Distal spiral or buckle fracture of the tibia/fibula
0-11 mos	Any type of fracture Exceptions For the following fractures if there are no clinical concerns: Distal buckle fracture of radius/ulna Distal spiral of the tibia/fibula in a cruising child > 9 mos w/ history of fall Linear, unilateral skull fracture in child ≥ 4 mos with plausible mechanism Height > 3 ft or fall with caregiver landing on child Clavicle fracture likely attributed to birth Acute fracture in infants < 22 days old or Healing fracture in infants < 30 days old
12-23 mos	Presence of any of the following: Rib fracture Classic metaphyseal fracture Complex or ping-pong skull fracture Humeral fracture with epiphyseal separation attributed to short fall (< 3 ft) Femur diaphyseal fracture attributed to fall from any height Exceptions Distal spiral fractures of the tibia/fibula with a history of a fall while walking/running Distal radial/ulna buckle fracture or clavicle fracture with a history of a fall on an outstretched hand

References

Development of Guidelines for Skeletal Survey in Young Children with Fractures

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Physical Abuse Clinical Pathway, Emergency Department, Outpatient Specialty Care and Primary Care – Skeletal Survey Recommendations

Indications and Exceptions for Obtaining a Skeletal Survey

References