Results of this study indicate that the addition of oblique chest views to the standard skeletal survey should be performed to rule out the possibility of physical abuse and that it added information to what was obtained from the two-view chest series, and increased the accuracy with which rib fractures were diagnosed. The study found that use of the four-view chest series changed the number of rib fractures diagnosed using the two-view chest series in 12 of the 22 study cases (54 percent). Overall, the four-view chest series differed significantly in the number of rib fractures diagnosed compared with the two-view chest series (p=.02, Wilcoxon matched-pairs signed-rank test) adding 19 rib fractures and excluding 6 rib fractures. Twenty-two cases with rib fractures were identified; of the 22 cases, 21 were diagnosed as “abuse” and 1 “not abuse” with metabolic bone disease. Of the 21 abuse cases, 62 percent were male with the mean of 4 months, with a range of 1-17 months; 74 percent were less than 4 months old and 91 percent were less than 1 year old; rib fractures represented the only evidence of injury in one case. The metabolic bone disease case was a 10-month-old female. The study is from the University of Utah Health Sciences Center Institutional Review Board. The study period was from October 2002 through October 2005. References