http://pediatrics.aappublications.org/content/early/2014/06/10/peds.2013-3242.full.pdf+html
Development of Guidelines for Skeletal Survey in Young Children With Fractures
JN Wood, O Fakeye, C Feudtner, V Mondestin… - Pediatrics, 2014 - Am Acad Pediatrics
OBJECTIVE: To develop guidelines for performing initial skeletal survey (SS) in children< 24
months old with fractures, based on available evidence and collective judgment of experts
from diverse pediatric specialties. METHODS: Following the Rand/UCLA Method, a ...
abstract
OBJECTIVE: To develop guidelines for performing initial skeletal survey
(SS) in children ,24 months old with fractures, based on available
evidence and collective judgment of experts from diverse pediatric
specialties.
METHODS: Following the Rand/UCLA Method, a multispecialty panel of
13 experts applied evidence from a literature review combined with
their own expertise in rating the appropriateness of performing
an SS for 525 clinical scenarios involving fractures in children ,24
months old. After discussion on the initial ratings, panelists rerated
SS appropriateness for 240 revised scenarios and deemed that SSs
were appropriate in 191 scenarios. The panelists then assessed in
which of those 191 scenarios SSs were not only appropriate, but also
necessary.
RESULTS: Panelists agreed that SS is “appropriate” for 191 (80%) of
240 scenarios rated and “necessary” for 175 (92%) of the appropriate
scenarios. Skeletal survey is necessary if a fracture is attributed to
abuse, domestic violence, or being hit by a toy. With few exceptions,
SS is necessary in children without a history of trauma. In children
,12 months old, SS is necessary regardless of the fracture type or
reported history, with rare exceptions. In children 12 to 23 months
old, the necessity of obtaining SS is dependent on fracture type.
CONCLUSIONS: A multispecialty panel reached agreement on multiple
clinical scenarios for which initial SS is indicated in young children
with fractures, allowing for synthesis of clinical guidelines with the
potential to decrease disparities in care and increase detection of
abuse.
Pediatrics 2014;134:45–53
Development of Guidelines for Skeletal Survey in Young Children With Fractures
JN Wood, O Fakeye, C Feudtner, V Mondestin… - Pediatrics, 2014 - Am Acad Pediatrics
OBJECTIVE: To develop guidelines for performing initial skeletal survey (SS) in children< 24
months old with fractures, based on available evidence and collective judgment of experts
from diverse pediatric specialties. METHODS: Following the Rand/UCLA Method, a ...
abstract
OBJECTIVE: To develop guidelines for performing initial skeletal survey
(SS) in children ,24 months old with fractures, based on available
evidence and collective judgment of experts from diverse pediatric
specialties.
METHODS: Following the Rand/UCLA Method, a multispecialty panel of
13 experts applied evidence from a literature review combined with
their own expertise in rating the appropriateness of performing
an SS for 525 clinical scenarios involving fractures in children ,24
months old. After discussion on the initial ratings, panelists rerated
SS appropriateness for 240 revised scenarios and deemed that SSs
were appropriate in 191 scenarios. The panelists then assessed in
which of those 191 scenarios SSs were not only appropriate, but also
necessary.
RESULTS: Panelists agreed that SS is “appropriate” for 191 (80%) of
240 scenarios rated and “necessary” for 175 (92%) of the appropriate
scenarios. Skeletal survey is necessary if a fracture is attributed to
abuse, domestic violence, or being hit by a toy. With few exceptions,
SS is necessary in children without a history of trauma. In children
,12 months old, SS is necessary regardless of the fracture type or
reported history, with rare exceptions. In children 12 to 23 months
old, the necessity of obtaining SS is dependent on fracture type.
CONCLUSIONS: A multispecialty panel reached agreement on multiple
clinical scenarios for which initial SS is indicated in young children
with fractures, allowing for synthesis of clinical guidelines with the
potential to decrease disparities in care and increase detection of
abuse.
Pediatrics 2014;134:45–53
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