The Value of the Pediatric Skeletal Examination in the Autopsy of Children

The pediatric skeletal examination (PSE) is an autopsy technique recommended for pediatric cases suspicious for nonaccidental injury. The technique requires the reflection of the musculature and periosteum of the ribs, clavicles, long bones, and scapulae, and inspection of the bone surfaces and chondro-osseous interfaces. The technique is time consuming, labor intensive and possibly disfiguring. Therefore, the value of the technique must be measured against the cost.

The present study was designed to evaluate the impact of the PSE on the sensitivity of the autopsy. A non-randomized retrospective review of 94 autopsy reports was done. The cause and manner of death for each case was classified as blunt force trauma and homicide. Half of the sample received a PSE during the autopsy and half did not.

The number of rib and long bone fractures noted in the reports was significantly greater in the group that received the PSE. The number of cranial, scapular and clavicular fractures was not significantly different between the two groups. The PSE does not increase the visibility of the neurocranium; therefore, a difference in the number of cranial fractures was not expected. Scapular and clavicular fractures were rare in the study population. The insignificant difference between the two groups may be a reflection of the rarity of the fracture as opposed to the sensitivity of the PSE. The results of the study indicate that the PSE increases the sensitivity of the pediatric autopsy with respect to long bone and rib fractures.