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1.
Pediatr Radiol ; 53(5): 832-843, 2023 05.
Artículo en Inglés | MEDLINE | ID: mdl-36517574

RESUMEN

BACKGROUND: The knowledge, awareness and professionalism of health care providers in the field of child protection are crucial in identifying and reporting suspected child abuse. Radiologic technologists and radiologists play a vital role in the diagnosis of suspected physical child abuse. OBJECTIVE: To assess current practice, knowledge and awareness of child abuse among radiologic technologists and radiologists in Saudi Arabia. MATERIALS AND METHODS: We distributed an internet-based questionnaire to radiologic technologists and radiologists working in Saudi Arabia via national radiology societies and social media channels over a 6-week period (27 October to 8 December 2021). Survey questions covered knowledge regarding child abuse, professional practice in radiology departments in Saudi Arabia in cases of suspected physical abuse (SPA), and knowledge of the national legislation and reporting and acting procedures in child abuse. RESULTS: A total of 315 respondents (224 radiologic technologists and 91 radiologists) participated in this study. The median score for knowledge of abuse was higher amongst radiologists (4.8) than radiologic technologists (4.0); P < 0.001. In total, 210 (93.8%) radiologic technologists and 61 (67.0%) radiologists reported that there was no protocol (i.e. skeletal survey) at their hospital for imaging children with SPA. Most radiologic technologists had no training in paediatric radiology (165/224, 73.7%) and most radiologists had received no training in evaluating imaging performed for SPA (73/91, 80.2%). More than half of respondents - 131 (58.5%) radiologic technologists and 44 (48.4%) radiologists - were not familiar with the reporting and acting procedures at their hospitals in cases of child abuse. CONCLUSION: Although radiologic technologists and radiologists in Saudi Arabia have good knowledge and awareness of child abuse in general, they lack specific knowledge of the reporting and acting procedures at their hospitals in cases of suspected child abuse. National imaging guidelines and training courses are needed to develop appropriate skills in the recognition, imaging and reporting of SPA in infants and young children in Saudi Arabia.


Asunto(s)
Maltrato a los Niños , Radiología , Humanos , Niño , Preescolar , Arabia Saudita , Maltrato a los Niños/diagnóstico , Radiólogos , Radiología/educación , Práctica Profesional , Encuestas y Cuestionarios
2.
Pediatr Radiol ; 53(4): 752-767, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36856756

RESUMEN

In infants without a history of trauma, subdural haemorrhages should raise the concern for an abusive head injury, particularly when they are associated with bridging vein clotting/rupture or with septations. However, non-haemorrhagic, fluid-appearing subdural collections (also called hygromas) may also be the result of abuse. Subdural collections have also been uncommonly observed in patients with benign enlargement of the subarachnoid spaces (BESS) and a few large-scale studies accurately investigate the incidence and the significance. Currently, there is a wide variation of practices in children with BESS and subdural collections. Due to the social risks associated with abuse evaluation and the perceived risk of radiation exposure, there might be a reluctance to fully evaluate these children in some centres. The diagnosis of physical abuse cannot be substantiated nor safely excluded in infants with BESS and subdural collection(s), without investigation for concomitant traumatic findings. The exact prevalence of occult injuries and abuse in these infants is unknown. In macrocephalic infants with subdural collections and imaging features of BESS, thorough investigations for abuse are warranted and paediatricians should consider performing full skeletal surveys even when fundoscopy, social work consult, and detailed clinical evaluation are unremarkable.


Asunto(s)
Maltrato a los Niños , Traumatismos Craneocerebrales , Lactante , Niño , Humanos , Hematoma Subdural/epidemiología , Maltrato a los Niños/diagnóstico , Traumatismos Craneocerebrales/diagnóstico , Espacio Subaracnoideo/diagnóstico por imagen , Abuso Físico , Estudios Retrospectivos
3.
Pediatr Radiol ; 53(4): 739-751, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36879046

RESUMEN

This second roundtable discussion was convened at the 56th European Society of Paediatric Radiology (ESPR) 2022 Annual Meeting in Marseille, France, to discuss controversial aspects of imaging in child abuse. The following topics were discussed: Fracture dating-the published literature is broadly similar with respect to the identification of the radiographic stages of bony healing. The non-expert/general radiologist is encouraged to use broad descriptors of fracture healing (acute, healing or old) within their reports, rather than attempting to date fractures. The more experienced/expert radiologist, who may provide a timeframe/range to assist the courts, should be aware that any published timeframes are not absolute and that recent research indicates that the rate of healing may differ according to the bone affected and the age of the patient. Whole spine imaging in suspected abusive head trauma-this is recommended to enable a complete assessment of the neuraxis when abusive head trauma is suspected or diagnosed, particularly in the presence of intracranial and cervical subdural haemorrhage and cervical ligamentous injury. Cranial imaging in suspected physical abuse-both computed tomography (CT) and magnetic resonance imaging (MRI) remain complimentary depending on the clinical context in which they are used with CT remaining first-line in the assessment of children with (suspected abusive) head trauma prior to an early MRI. MRI is superior in its assessment of parenchymal injury and may be employed as first-line in age appropriate asymptomatic siblings of a child with suspected physical abuse.


Asunto(s)
Maltrato a los Niños , Traumatismos Craneocerebrales , Fracturas Óseas , Radiología , Niño , Humanos , Lactante , Traumatismos Craneocerebrales/diagnóstico , Imagen por Resonancia Magnética/métodos , Fracturas Óseas/diagnóstico por imagen , Maltrato a los Niños/diagnóstico , Estudios Retrospectivos
4.
Arch Dis Child Educ Pract Ed ; 108(5): 326-329, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-35177487

RESUMEN

Palpable cervical lymph nodes are common in children and are a frequent reason for presentation to both primary and secondary care. Enlarged lymph nodes are most commonly the result of self-limiting infection, and in children, are rarely the first indicator of a malignant process. This article presents an evidenced-based approach to evaluating these patients.


Asunto(s)
Ganglios Linfáticos , Linfadenopatía , Humanos , Niño , Cuello/diagnóstico por imagen , Derivación y Consulta
5.
Eur Radiol ; 31(9): 7088-7097, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33725188

RESUMEN

OBJECTIVES: To assess the diagnostic performance of chest CT in the detection of rib fractures in children investigated for suspected physical abuse (SPA). METHODS: Medline, Web of Science and Cochrane databases were searched from January 1980 to April 2020. The QUADAS-2 tool was used to assess the quality of the eligible English-only studies following which a formal narrative synthesis was constructed. Studies reporting true-positive, false-positive, true-negative, and false-negative results were included in the meta-analysis. Overall sensitivity and specificity of chest CT for rib fracture detection were calculated, irrespective of fracture location, and were pooled using a univariate random-effects meta-analysis. The diagnostic accuracy of specific locations along the rib arc (anterior, lateral or posterior) was assessed separately. RESULTS: Of 242 identified studies, 4 met the inclusion criteria. Of these, 2 were included in the meta-analysis. Chest CT identified 142 rib fractures compared to 79 detected by initial skeletal survey chest radiographs in live children with SPA. Post-mortem CT (PMCT) has low sensitivity (34%) but high specificity (99%) in the detection of rib fractures when compared to the autopsy reference standard. PMCT has low sensitivity (45%, 21% and 42%) but high specificity (99%, 97% and 99%) at anterior, lateral and posterior rib locations, respectively. CONCLUSIONS: Chest CT detects more rib fractures than initial skeletal survey chest radiographs in live children with SPA. PMCT has low sensitivity but high specificity for detecting rib fractures in children investigated for SPA. KEY POINTS: • PMCT has low sensitivity (34%) but high specificity (99%) in the detection of rib fractures; extrapolation to CT in live children is difficult. • No studies have compared chest CT with the current accepted practice of initial and follow-up skeletal survey chest radiographs in the detection of rib fractures in live children investigated for SPA.


Asunto(s)
Fracturas de las Costillas , Autopsia , Niño , Humanos , Abuso Físico , Fracturas de las Costillas/diagnóstico por imagen , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X
6.
Pediatr Radiol ; 51(9): 1621-1625, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33688990

RESUMEN

BACKGROUND: Despite the publication of a national patient safety alert in 2016, inadvertent feeding through misplaced nasogastric tubes continues to occur, either through failure to review the radiograph, misinterpretation of it, or failure to communicate the results. OBJECTIVE: The objectives were to determine whether training in a new pathway introduced to avoid these "never events" was followed and whether radiographer comments and prompt communication of results could reduce risk and improve patient safety in relation to nasogastric tube placement in children. MATERIALS AND METHODS: Following radiographer training in interpretation of nasogastric tube position and use of a commenting proforma and communication pathway, we reviewed all radiographs obtained to check nasogastric tubes performed over a 13-month period in children 0-16 years of age. Then we assessed accuracy of the radiographer comments, adherence to the pathway, and any practice change in children with misplaced nasogastric tubes. RESULTS: We reviewed 282 nasogastric tube check radiographs. For 262 radiographs (92.9%) the pathway was followed correctly. Of the total 282 radiographs, 240 (85%) were immediately reported using the standardised commenting proforma, and 235 radiographer comments were affirmed by the radiologist (97% accuracy, confidence interval 0.95-0.99). Of the immediately reported radiographs, 213 (88.8%) nasogastric tubes were considered to be safe for use. Four (1.7%) of the immediately reported nasogastric tubes were misplaced in a bronchus, and the report communicated to the clinical team resulted in removal or re-siting of the tubes. CONCLUSION: Nasogastric tube check radiographs in children can be reported accurately by radiographers trained in their interpretation and the results promptly communicated to clinical staff, improving safety in relation to nasogastric tube placement in children.


Asunto(s)
Intubación Gastrointestinal , Seguridad del Paciente , Niño , Humanos , Intubación Gastrointestinal/efectos adversos , Errores Médicos/prevención & control , Radiografía , Radiólogos
9.
Health Technol Assess ; 21(48): 1-164, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28862129

RESUMEN

BACKGROUND: There is little current consensus regarding the route or duration of antibiotic treatment for acute osteomyelitis (OM) and septic arthritis (SA) in children. OBJECTIVE: To assess the overall feasibility and inform the design of a future randomised controlled trial (RCT) to reduce the duration of intravenous (i.v.) antibiotic use in paediatric OM and SA. DESIGN: (1) A prospective service evaluation (cohort study) to determine the current disease spectrum and UK clinical practice in paediatric OM/SA; (2) a prospective cohort substudy to assess the use of targeted polymerase chain reaction (PCR) in diagnosing paediatric OM/SA; (3) a qualitative study to explore families' views and experiences of OM/SA; and (4) the development of a core outcome set via a systematic review of literature, Delphi clinician survey and stakeholder consensus meeting. SETTING: Forty-four UK secondary and tertiary UK centres (service evaluation). PARTICIPANTS: Children with OM/SA. INTERVENTIONS: PCR diagnostics were compared with culture as standard of care. Semistructured interviews were used in the qualitative study. RESULTS: Data were obtained on 313 cases of OM/SA, of which 218 (61.2%) were defined as simple disease and 95 (26.7%) were defined as complex disease. The epidemiology of paediatric OM/SA in this study was consistent with existing European data. Children who met oral switch criteria less than 7 days from starting i.v. antibiotics were less likely to experience treatment failure (9.6%) than children who met oral switch criteria after 7 days of i.v. therapy (16.1% when switch was between 1 and 2 weeks; 18.2% when switch was > 2 weeks). In 24 out of 32 simple cases (75%) and 8 out of 12 complex cases (67%) in which the targeted PCR was used, a pathogen was detected. The qualitative study demonstrated the importance to parents and children of consideration of short- and long-term outcomes meaningful to families themselves. The consensus meeting agreed on the following outcomes: rehospitalisation or recurrence of symptoms while on oral antibiotics, recurrence of infection, disability at follow-up, symptom free at 1 year, limb shortening or deformity, chronic OM or arthritis, amputation or fasciotomy, death, need for paediatric intensive care, and line infection. Oral switch criteria were identified, including resolution of fever for ≥ 48 hours, tolerating oral food and medicines, and pain improvement. LIMITATIONS: Data were collected in a 6-month period, which might not have been representative, and follow-up data for long-term complications are limited. CONCLUSIONS: A future RCT would need to recruit from all tertiary and most secondary UK hospitals. Clinicians have implemented early oral switch for selected patients with simple disease without formal clinical trial evidence of safety. However, the current criteria by which decisions to make the oral switch are made are not clearly established or evidence based. FUTURE WORK: A RCT in simple OM and SA comparing shorter- or longer-course i.v. therapy is feasible in children randomised after oral switch criteria are met after 7 days of i.v. therapy, excluding children meeting oral switch criteria in the first week of i.v. therapy. This study design meets clinician preferences and addresses parental concerns not to randomise prior to oral switch criteria being met. FUNDING: The National Institute for Health Research Health Technology Assessment programme.


Asunto(s)
Enfermedad Aguda , Administración Intravenosa/métodos , Antibacterianos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Osteomielitis/tratamiento farmacológico , Adolescente , Niño , Preescolar , Estudios de Factibilidad , Humanos , Lactante , Padres , Estudios Prospectivos , Reino Unido
11.
Paediatr Respir Rev ; 3(1): 59-69, 2002 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12065184

RESUMEN

The immunodeficiency states in children may be sub-divided into two major groups; congenital (primary), and acquired (secondary). The spectrum of illness and imaging appearances are similar, regardless of the underlying cause of immunodeficiency. All immunodeficiency states are associated with an increased susceptibility to infection and neoplasia, with the lymphoproliferative disorders being the most frequent. However, the type of infections encountered and the risks of neoplasia are influenced by the underlying defect (whether predominantly humoral or cell mediated), the use of immunosuppressive drugs or radiotherapy as well as the length of immunosuppression.A working knowledge of the underlying likely immune defect is therefore important when interpreting imaging findings in children with immunodeficiency states. The typical imaging appearances of the common infectious, non-infectious and neoplastic complications of immunodeficiency are described.


Asunto(s)
Huésped Inmunocomprometido , Síndromes de Inmunodeficiencia/complicaciones , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/etiología , Radiografía Torácica/métodos , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico por imagen , Síndrome de Inmunodeficiencia Adquirida/diagnóstico por imagen , Niño , Humanos , Terapia de Inmunosupresión/efectos adversos , Tomografía Computarizada por Rayos X , Trasplante/efectos adversos
12.
Eur Radiol ; 14(6): 990-4, 2004 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-14872276

RESUMEN

The objective of this study is to assess computed tomography (CT) changes, both volume estimates and subjective features, following preoperative chemotherapy for nephroblastoma (Wilms' tumour) in patients treated on the United Kingdom Children's Cancer Study Group Wilms' Tumour Study-3 (UKW-3) protocol and to compare CT changes and histopathological classification. Twenty-one nephroblastomas in 15 patients treated on UKW-3 were included. All patients were examined by CT before and after preoperative chemotherapy treatment. CT images were reviewed (estimated volume change and subjectively assessed features). CT changes were compared to histopathological classification. Of the 21 tumours, all five high-risk tumours decreased in volume following chemotherapy (median -79%; range -37 to -91%). The sole low-risk tumour decreased in volume by 98%. Ten intermediate-risk tumours decreased in volume (median -72%; range -6 to -98%) and five intermediate-risk tumours increased (median +110%; range +11 to +164%). None of the five high-risk tumours, compared to 15/16 intermediate or low-risk tumours, became less dense and/or more homogeneous, or virtually disappeared, following chemotherapy. Volume change following chemotherapy did not relate to histopathological risk group. Changes in subjectively assessed qualitative CT features were more strongly related to histopathological risk group.


Asunto(s)
Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Tomografía Computarizada Espiral , Tumor de Wilms/diagnóstico por imagen , Tumor de Wilms/patología , Quimioterapia Adyuvante , Niño , Preescolar , Femenino , Humanos , Lactante , Neoplasias Renales/clasificación , Neoplasias Renales/tratamiento farmacológico , Neoplasias Renales/cirugía , Masculino , Tumor de Wilms/clasificación , Tumor de Wilms/tratamiento farmacológico , Tumor de Wilms/cirugía
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