Table 2.

Association of Demographic and Clinical Characteristics with Likelihood of Skeletal Survey Utilization

Characteristics	Skeletal Survey Indication	Study	LR+ (95% CI)a	LR− (95% CI)a	pa
Age (months)
0-5 vs. 6-11	Siblingsb	Lindberg, 2012	1.5 (0.6–3.9)	0.7 (0.4–1.3)	0.44
0-5 vs. 6-11	Suspected abuse	Lindberg, 2014	1.2 (1.0–1.4)	0.8 (0.6–1.0)	0.037
0-5 vs. 6-11	Fracture: isolated skull	Wood, 2009	0.9 (0.8–1.1)	1.1 (0.9–1.4)	0.41
0-6 vs. 7-11	Head injury: ICH	Wood, 2010	1.0 (0.9–1.0)	1.1 (0.9–1.2)	0.28
0-11 vs. 12-23	Suspected abuse	Hansen, 2009	2.6 (1.1–6.0)	0.4 (0.2–0.5)	<0.001
0-11 vs. 12-23	Diagnosed abuse	Hicks, 2007	2.1 (1.1–4.1)	0.4 (0.2–0.6)	0.001
0-11 vs. 12-23	Head injury: severe	Hymel, 2015	1.2 (1.1–1.4)	0.5 (0.4–0.8)	0.002
0-11 vs. 12-23	Siblingsb	Lindberg, 2012	1.6 (0.8–3.0)	0.8 (0.6–1.1)	0.21
0-11 vs. 12-23	Suspected abuse	Lindberg, 2014	1.4 (1.3–1.6)	0.5 (0.4–0.6)	<0.001
0-11 vs. 12-23	Diagnosed abuse	Wood, 2012	1.1 (1.1–1.2)	0.7 (0.6–0.7)	<0.001
0-11 vs. 12-23	Diagnosed abuse	Wood, 2015	1.5 (1.4–1.5)	0.5 (0.4–0.6)	<0.001
0-11 vs. 12-35	Fracture: skull or long bone	Lane, 2002	1.4 (1.2–1.6)	0.6 (0.5–0.8)	<0.001
12-23 vs. 24-35	Head injury: severe	Hymel, 2015	1.4 (1.0–1.9)	0.7 (0.5–0.9)	0.021
12-23 vs. 24-35	Suspected abuse	Lindberg, 2014	1.4 (1.2–1.6)	0.7 (0.6–0.8)	<0.001
Gender
Male vs. female	Head injury: minor	Anderst, 2008	1.1 (0.8–1.4)	0.9 (0.7–1.3)	0.60
Male vs. female	Siblingsb	Lindberg, 2012	1.5 (0.8–2.8)	0.8 (0.6–1.1)	0.19
Male vs. female	Head injury: unwitnessed	Rangel, 2009	1.2 (0.9–1.6)	0.8 (0.6–1.1)	0.17
Male vs. female	Head injury: ICH	Wood, 2010	0.9 (0.9–1.0)	1.1 (1.0–1.2)	0.012
Insurancec
Public/none vs. private insurance	Head injury: minor	Anderst, 2008	1.1 (0.9–1.3)	0.9 (0.6–1.4)	0.63
Public/none vs. private insurance	Fracture: skull or long bone	Lane, 2002	1.6 (1.3–1.9)	0.6 (0.4–0.7)	<0.001
Public/none vs. private insurance	Fracture: isolated skull	Laskey, 2013	1.3 (0.9–2.0)	0.6 (0.4–1.0)	0.073
Public/none vs. private insurance	Siblingsb	Lindberg, 2012	1.0 (0.9–1.1)	1.7 (0.4–7.3)	0.73
Public/none vs. private insurance	Head injury: unwitnessed	Rangel, 2009	3.0 (1.8–4.8)	0.4 (0.3–0.5)	<0.001
Public/none vs. private insurance	Fracture: isolated skull	Wood, 2009	1.4 (1.1–1.8)	0.7 (0.6–0.9)	0.002
Public/none vs. private insurance	Head injury: ICH	Wood, 2010	1.5 (1.4–1.6)	0.4 (0.4–0.5)	<0.001
Race/ethnicity
Hispanic vs. non-Hispanic	Head injury: minor	Anderst, 2008	0.8 (0.7–1.1)	1.4 (1.0–2.1)	0.10
Minority vs. white	Fracture: skull or long bone	Lane, 2002	2.0 (1.6–2.5)	0.5 (0.4–0.6)	<0.001
Minority vs. white	Fracture: isolated skull	Laskey, 2013	0.9 (0.4–1.9)	1.0 (0.8–1.3)	0.78
Minority vs. white	Siblingsb	Lindberg, 2012	1.7 (1.0–2.8)	0.7 (0.5–0.9)	0.027
Black vs. white	Head injury: unwitnessed	Rangel, 2009	3.4 (1.3–9.1)	0.8 (0.7–0.9)	0.006
Black vs. white	Fracture: isolated skull	Wood, 2009	1.3 (1.0–1.8)	0.8 (0.7–1.0)	0.043
Black vs. white	Head injury: ICH	Wood, 2010	2.0 (1.6–2.4)	0.8 (0.7–0.8)	<0.001
Type of Injury
Burnsc vs. other	Diagnosed abuse	Hicks, 2007	0.5 (0.2–1.1)	1.2 (0.9–1.7)	0.15
Bruisingd vs. other	Suspected abuse	Harper, 2014	1.2 (0.6–2.2)	1.0 (0.9–1.1)	0.73
Head Injury Characteristics
CT findings: positive vs. negative	Head injury: minor	Anderst, 2008	3.6 (2.6–4.9)	0.4 (0.3–0.6)	<0.001
Severe vs. mild/moderate	Head injury: ICH	Wood, 2010	1.6 (1.5–1.9)	0.7 (0.7–0.8)	<0.001
Severe vs. mild/moderate	Head injury: unwitnessed	Rangel, 2009	1.2 (0.9–1.7)	0.8 (0.6–1.1)	0.27
Skull fracture: present vs. absent	Head injury: ICH	Wood, 2010	3.0 (2.7–3.4)	0.4 (0.4–0.5)	<0.001
Complex vs. simple skull fracture	Fracture: isolated skull	Wood, 2009	1.1 (0.9–1.5)	0.9 (0.8–1.1)	0.32
Additional Injuries Present
Yes vs. no	Fracture: isolated skull	Wood, 2009	6.4 (1.4–29.1)	0.9 (0.9–1.0)	0.009
Yes vs. no	Head injury: ICH	Wood, 2010	2.7 (1.9–3.8)	0.9 (0.9–1.0)	<0.001
Red Flags on History
Red flag for abusee: yes/no	Fracture: isolated skull Wood, 2009		3.4 (2.4–4.9)	0.6 (0.5–0.7)	<0.001
Delay in seeking care ≥6 hours: yes/no	Head injury: minor	Anderst, 2008	3.0 (1.9–4.7)	0.7 (0.6–0.9)	<0.001
No history of trauma: yes/no	Head injury: minor	Anderst, 2008	6.2 (2.6–14.5)	0.8 (0.7–1.0)	<0.001
Hospital Clinical Guideline
Present vs. none	Fracture: any	Higginbotham, 2014	1.7 (1.3–2.2)	0.5 (0.4–0.6)	<0.001
Present vs. none	Head injury: unwitnessed	Rangel, 2009	2.0 (1.0–4.2)	0.9 (0.8–1.0)	0.0495

Note. Abbreviations: CI, confidence interval; CT, computed tomography; LR, likelihood ratio; ICH, intracranial hemorrhage.

^aCalculated using a two-sided chi square test or, when a cell count was < 10, two-sided Fisher’s exact test. P value of 0.05 or less considered statistically significant.

^bStudy included siblings and other household contacts of children diagnosed with physical abuse.

^cInjury was the primary reason for abuse consultation. All children were diagnosed with abuse.

^dBruising was isolated. All children < 6 months old and were evaluated for suspected physical abuse.

^eRed flag for abuse was defined as delay in seeking care >72 hours, no history of trauma, changing or conflicting history, or past child protective services report.