Detect Injuries Correlated with Child Abuse Posterior Rib Fractures

Purpose	Detect posterior rib fractures which are injuries correlated with Nonaccidental Trauma (NAT).
Tag(s)
Panel	Pediatric Panel
Define-AI	19010005
Originator	Pediatrics Panel
Lead	Steven Blumer
Panel Chair	Steven Blumer
Panel Reviewers	Pediatric Panel
License	Creative Commons 4.0
Status	Public Commenting
RadElement Set	RDES93

Clinical Implementation

Value Proposition

Radiologists may be the first clinical staff to suspect non-accidental trauma when they are able to identify injuries associated with this entity. Identification of these injuries is critically important as it can save a child from potential serious long-term morbidity and mortality. A skeletal survey is performed in cases of suspected abuse to assess and document the extent of skeletal injuries. Different types of fractures have been recognized as highly specific to non-accidental injuries (rather than accidental injury).

Two such fractures include: Metaphyseal fractures (also known as classic metaphyseal lesions (CML), metaphyseal corner fractures or bucket handle fractures). It can be seen in up to 39-50% of abused infants less than 18 months of age. It is said to be virtually pathognomonic of Nonaccidental Injury. Rib fractures, especially of the posterior ribs may have no overlying bruising, although vigorous cardiopulmonary resuscitation can occasionally cause anterior rib fractures, posterior rib fractures do not occur in this setting.

Narrative(s)

A skeletal survey is ordered for a young child for suspected non accidental trauma.

Workflow Description

A skeletal survey performed in a young child for suspected non accidental trauma. The images in the skeletal survey are taken and sent to PACS and the AI engine. The algorithm identifies if any posterior rib fractures are present.

Considerations for Dataset Development

Procedures

Skeletal Survey

Age

[0,3]

In-Patient Location

Typically

Positioning

APPENDICULAR SKELETON

Right and left Humeri (AP)

Right and left Forearms (AP)

Right and left Hands (PA or oblique)

Right and left Femurs (AP)

Right and left Lower legs (AP)

Right and left Feet (AP)

AXIAL SKELETON

Thorax (AP, lateral, right and left obliques), to include sternum, ribs, thoracic and upper lumbar spine

Abdomen, to include the pelvis (AP) Lumbosacral spine (lateral)

Skull (frontal and lateral), cervical spine (if not completely visualized on lateral skull)

Technical Specifications

Inputs

DICOM Study

Procedure	Skeletal Survey
Views	AP Views of humeri, forearms, hands, femurs, lower legs, feet, thorax, abdomen and skull (including upper cervical spine) Lateral views of thorax (including sternum, ribs, thoracic and upper lumbar spine), lumbosacral spine, skull (including cervical spine)
Data Type	DICOM
Modality	Radiographs
Body Region	Axial and Appendicular Skeletons
Anatomic Focus	Osseous structures

Primary Outputs

Posterior Rib Fracture(s) Detection

RadElement ID	RDE562
Definition	Presence or absence of posterior rib fracture(s).
Data Type	Categorical
Value Set	Absent Present Equivocal
Units	N/A

Affected Rib Segmentation

RadElement ID	RDE561
Definition	If posterior rib fracture is present, highlight affected ribs.
Data Type	Coordinates
Value Set	N/A
Units	N/A

Future Development Ideas

Algorithms that detect other injuries that are highly specific for nonaccidental trauma that can be seen on skeletal surveys such as fractures of the skull, scapula, sternum, digits, and outer third of the clavicle.
Algorithms that are able to date fractures seen on skeletal surveys.

Related Datasets

No known related public datasets at this time, please alert us if you know of any.