JRSM > Volume 98, Number 8 > Pp. 386-387

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Letters

Wrongful diagnosis of child abuse

David Nichols

Raigmore Hospital, Inverness IV2 3UJ, Scotland, UK

I make no claim to special expertise in the radiology of the battered baby nor indeed in the general field of child abuse, but I know a shaky argument buttressed by a smokescreen reference when I see one. Dr Le Fanu (June 2005 JRSM¹) states baldly '... radiologists' misinterpretation of normal variants of ossification in the first year of life as being metaphyseal fractures accounts for the obvious discrepancy between the findings of multiple fractures on skeletal survey and the absence of any clinical signs of abusive injury'. The quoted reference² is to a pictorial essay on normal appearances, published in 1991 to help familiarize radiologists with the range of normality, and containing no evidence to support such a statement. Indeed knowledge of such normal variants is the radiologist's stock in trade. While there may of course have been isolated cases of radiological misinterpretation in the past, a sweeping generalization like this without a shred of evidence merely damages Le Fanu's case (which, after all, is that doctors should have a thorough balanced grasp of the relevant scientific evidence before giving an expert opinion—to paraphrase his opening sentence). In my experience radiologists are acutely aware of the difficulties and sensitivities involved in this area and the X-rays in any given case are as a result likely to have been extensively reviewed by colleagues with special expertise long before appearing as evidence.

REFERENCES

1. Le Fanu J. Wrongful diagnosis of child abuse—a master theory. J R Soc Med2005; 98:249 -54[Free Full Text]

2. Kleinman PK, Belange PL, Karellasa A, Spevak MR. Normal metaphyseal radiologic variants not to be confused with the findings of infant abuse. Am J Roengenol1991; 156:781 -3[Abstract/Free Full Text]

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This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nichols, D. Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?