# Effectiveness of low dose computed tomography to detect fractures in paediatric suspected physical abuse: a systematic review

## TL;DR

This review examines if low-dose CT can replace X-rays for detecting fractures in children suspected of physical abuse.

## Contribution

The paper highlights the lack of diagnostic accuracy studies comparing low-dose CT to X-rays in this context.

## Key findings

- Only three case series were found, which were insufficient to compare LDCT and X-ray accuracy.
- A phantom and post-mortem CT study are recommended to evaluate LDCT's potential for detecting subtle fractures.
- Current evidence does not support replacing skeletal surveys with LDCT for suspected child abuse.

## Abstract

The skeletal survey X-ray series is the current ‘gold standard’ when investigating suspected physical abuse (SPA) of children, in addition to a non-contrast computed tomography (CT) brain scan. This systematic literature review synthesised findings of published research to determine if low dose computed tomography (LDCT) could detect subtle fractures and therefore replace the skeletal survey X-ray series in the investigation of SPA in children aged under 3 years.

Five electronic databases and grey literature were systematically searched from their inception to 28 April 2022. Primary studies were included where the population comprised paediatric patients up to 16 years and LDCT was used to detect fractures associated with SPA. Studies involving imaging investigations of the head, standard dose CT examinations or accidental trauma were excluded.

Three studies met the inclusion criteria, all of which were case series. These studies did not report many of the criteria required to compare the accuracy of LDCT to X-ray, i.e. they did not meet the criteria for a diagnostic accuracy test. Therefore, it is difficult to conclude from the case series if LDCT is accurate enough to replace X-rays.

Due to the gap in current literature, a phantom study and subsequent post-mortem CT study are recommended as the primary investigative methods to assess the ability of low-dose CT to identify the subtle fractures associated with SPA and to calculate how low the achievable CT dose can be.

The online version contains supplementary material available at 10.1007/s00414-024-03214-2.