Seizure in a young infant: choosing the next test

How it is diagnosed

When a boy of 2 months presents with a seizure, the next test to order is a head CT scan. It comes ahead of metabolic screening, ahead of a serum calcium level and ahead of a sepsis workup.

Ribs fractures are what is recorded alongside that answer, and the table that sits with it is the one of injuries detected on radiographic imaging that are specific for child abuse:

• Highly specific injuries: classic metaphyseal lesions; rib fractures, especially posteromedial; sternal, scapular and spinous process fractures.
• Moderately specific injuries: multiple fractures; fractures in different phases of healing; epiphyseal separations; vertebral body fractures and subluxations; digital fractures; complex skull fractures.
• Common but of low specificity: clavicular fractures.

The table itself adds that quantitative information for high or moderate specificity is unavailable.