CT more accurate than x-rays for detecting rib fractures during child abuse investigations

Chest CT is more accurate than chest x-rays for postmortem rib fracture detection, according to research published in The Lancet Child & Adolescent Health. This finding, the authors explained, could lead to improved child abuse investigations.

“Internationally, chest radiography is the standard investigation for identifying rib fractures in suspected physical abuse in infants,” wrote Susan C Shelmerdine, MBBS, Department of Clinical Radiology at London’s Great Ormond Street Hospital for Children, and colleagues. “Several small observation studies in children have found that chest CT can provide greater accuracy than radiography for fracture detection, potentially aiding medicolegal proceedings in abuse cases; however, to our knowledge, this greater accuracy has not been comprehensively evaluated.”

The authors studied data from 25 children between the ages of one month old and 7 years old. All children had a post-mortem skeletal survey, CT and a full autopsy between Jan. 1, 2012, and Jan. 1, 2017 as part of a forensic investigation. A team of 38 radiologists viewed the x-rays from these cases and reported any rib fractures they saw. One month later, those radiologists viewed CTs from those same cases, but in a random order.

Across all participating radiologists, three-times as many rib fractures were correctly detected using chest CTs than when using chest x-rays. CT also had a higher sensitivity for detection of the correct rib (62.4 percent vs 23.1 percent). Radiologists were also more confident when using the CT images than when using x-rays.

“Our data indicate that chest CT would provide greater accuracy than radiography in the post-mortem investigation of rib fractures,” the authors wrote. “The diagnostic accuracy of CT should be studied in live children to assess the wider applicability of our results.”