Table 3.

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

Characteristics	Skeletal Survey Indication	Study	LR+ (95% CI)a	LR− (95% CI)a	pa
Age (months)
0–5 vs. 6–11	Suspected abuse	Duffy, 2011	1.3 (1.1–1.5)	0.5 (0.3–0.9)	0.005
0–5 vs. 6–11	Siblingsb	Lindberg, 2012	1.3 (0.8–2.2)	0.6 (0.3–1.6)	0.49
0–5 vs. 6–11	Suspected abuse	Lindberg, 2014	1.1 (1.0–1.2)	0.8 (0.7–1.0)	0.020
0–5 vs. 6–11	Fracture: isolated skull	Laskey, 2013	1.5 (1.3–1.7)	0.0 (NA)	0.11
0–11 vs. 12–23	Suspected abuse	Barber, 2013/2015c	1.0 (1.0–1.1)	0.8 (0.5–1.3)	0.31
0–11 vs. 12–23	Diagnosed abuse	Belfer, 2001	1.0 (0.8–1.3)	0.9 (0.3–2.6)	1.00
0–11 vs. 12–23	Suspected abuse	Day, 2006	1.1 (0.9–1.3)	0.6 (0.1–4.6)	1.00
0–11 vs. 12–23	Suspected abuse	Duffy, 2011	1.1 (1.0–1.3)	0.5 (0.3–1.0)	0.046
0–11 vs. 12–23	Abusive burns	Fagen, 2015	1.2 (0.6–2.1)	0.8 (0.3–2.3)	1.00
0–11 vs. 12–23	Suspected abuse	Hansen, 2009	1.1 (0.9–1.2)	0.8 (0.5–1.3)	0.45
0–11 vs. 12–23	Abusive burns	Hicks, 2007	2.6 (0.9–7.6)	0.5 (0.2–1.6)	0.14
0–11 vs. 12–23	Head injury:	Hymel, 2015	1.0 (0.9–1.2)	0.8 (0.5–1.5)	0.55
0–11 vs. 12–23	Suspected abuse	Karmazyn, 2011	1.1 (1.0–1.3)	0.6 (0.4–0.9)	0.016
0–11 vs. 12–23	Siblingsb	Lindberg, 2012	2.8 (1.8–4.1)	0.3 (0.1–0.7)	<0.001
0–11 vs. 12–23	Suspected abuse	Lindberg, 2014	1.1 (1.1–1.2)	0.6 (0.5–0.8)	<0.001
0–11 vs. 12–23	Fracture: abusive	Ravichandiran, 2010	1.1 (0.9–1.2)	0.8 (0.4–1.3)	0.33
12–23 vs. 24–35	Suspected abuse	Day, 2006	1.0 (0.2–4.6)	1.0 (0.2–4.6)	1.00
12–23 vs. 24–35	Head injury: severe	Hymel, 2015	1.0 (0.7–1.5)	1.0 (0.5–2.0)	1.00
12–23 vs. 24–35	Suspected abuse	Lindberg, 2014	1.0 (0.8–1.2)	1.0 (0.8–1.4)	0.82
12–23 vs. 24–35	Fracture: abusive	Ravichandiran, 2010	1.0 (0.7–1.3)	1.2 (0.5–2.7)	0.77
12–23 vs. 24–48	Suspected abuse	Barber, 2013/2015c	1.2 (0.9–1.6)	0.7 (0.4–1.3)	0.29
12–23 vs. 24–48	Diagnosed abuse	Belfer, 2001	1.7 (0.9–3.1)	0.4 (0.1–2.3)	0.33
12–23 vs. 24–59	Suspected abuse	Duffy, 2011	1.1 (0.7–1.6)	0.9 (0.5–1.7)	0.80
12–23 vs. 24–59	Abusive burns	Fagen, 2015	0.9 (0.3–2.7)	1.0 (0.5–2.0)	1.00
Gender
Male vs. female	Suspected abuse	Day, 2006	1.1 (0.7–1.9)	0.9 (0.5–1.6)	0.78
Male vs. female	Head injury: unwitnessed	Rangel, 2009	1.0 (0.8–1.2)	1.1 (0.7–1.5)	0.79
Insurance
Public/none vs. private insurance	Head injury: unwitnessed	Rangel, 2009	1.4 (1.2–1.6)	0.4 (0.2–0.7)	0.001
Race/ethnicity
Black vs. white	Head injury: unwitnessed	Rangel, 2009	0.8 (0.4–1.4)	1.1 (0.9–1.3)	0.39
Injury Typed
Fracture (non-skull) vs. other	Suspected abuse	Barber, 2015	1.5 (1.1–2.1)	0.8 (0.7–1.0)	0.02
Long bone fracture vs. othere	Suspected abuse	Barber, 2015	1.8 (1.3–2.5)	0.8 (0.7–0.9)	0.002
Bruisingf vs. other	Suspected abuse	Harper, 2014	0.9 (0.6–1.2)	1.0 (1.0–1.1)	0.39
Burns vs. other	Diagnosed abuse	Hicks, 2007	0.7 (0.3–1.8)	1.0 (0.9–1.2)	0.63
Head Injury Characteristics
Complex vs. simple skull fracture	Isolated skull fracture	Deye, 2013	0.6 (0.2–2.2)	1.1 (0.9–1.5)	0.74
Complex vs. simple skull fracture	Isolated skull fracture	Laskey, 2013	0.6 (0.1–4.1)	1.1 (0.8–1.4)	1.00
Severe vs. mild/moderate	Head injury: unwitnessed	Rangel, 2009	1.7 (1.3–2.1)	0.5 (0.3–0.8)	<0.001
Red Flags on History
Red flag for abuseg: yes/no	Isolated skull fracture	Laskey, 2013	2.4 (1.6–3.6)	0.3 (0.1–1.1)	0.01

Note. Abbreviations: CI, confidence interval; LR, likelihood ratio.

^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.

^cData presented in Barber, 2013 and Barber, 2015 were combined in this analysis, as they are for different age groups of the same study population and use the same definition of positive SS.

^dInjuries were not isolated, and children may have had > 1 presentation for which they underwent SS unless otherwise noted.

^eChildren who had their initial SS performed at an institution other than the study institution were excluded from this analysis.

^fBruising was not accompanied by other injuries. All children were < 6 months old.

^gRed flag for abuse is defined as no history of trauma, changing or conflicting histories, delay in care > 72 hours, prior CPS history, and/or additional injuries concerning for abuse.