Radiology : Recommended Radiological Studies Overview
When child abuse is suspected, the medical provider should perform a thorough medical evaluation. Consultants in radiology, ophthalmology, neurosurgery, general pediatric surgery, and other subspecialties may be needed. Providers should consider consulting a subspecialist in the field of child abuse pediatrics to ensure that the medical evaluation of the patient has been completed and the diagnosis accurate (Narang, Fingarson & Lukefar 2020).
Fractures due to syndromes, metabolic or systemic diseases, and other pre-existing conditions should be considered in the differential diagnosis of children. Family history, physical characteristics of the patient, parents or other relatives, laboratory and radiologic findings are important factors to consider when underlying conditions are suspected.
Guidelines for Children Suspected of Being Abused
- Children younger than the age of 2 years (24 months) should be screened for fractures with a skeletal survey (Christian et al 2015).
- Unenhanced head computed tomography (CT) of the head is recommended as the initial study for suspected intracranial injury for infants and children.
- In asymptomatic infants, where occult injuries are suspected, some centers perform CT or MRI (preferred if available) for infants less than 6 months. Older infants may be screened on a case-by-case basis.
- If available and the infant is clinically stable, fast MRI can replace head CTs for traumatic brain injury evaluations (Lindberg et al 2019).
- Contrast-enhanced CT of the abdomen/pelvis is recommended for suspected intra-abdominal or pelvic injury.
- Other tests, such as CT or MRI of the neck, may also be indicated when AHT is suspected.
The ACR Appropriateness Criteria – Suspected Physical Abuse - Child: protocols for when to obtain radiographic imaging in suspected physical abuse is published by the American College of Radiology and the Society for Pediatric Radiology. For the 2021 version see: https://gravitas.acr.org/PPTS/DownloadPreviewDocument?ReleaseId=2&DocId=186.
For more information on the evaluation for physical abuse, see: CHAMP Evaluation Guidelines for Suspected Child Physical Abuse. 2022: https://champprogram.com/pdf/guidelines-suspected-child-physical-abuse-june-2022.pdf.
