ACR Appropriateness Criteria^® Suspected Physical Abuse-Child

Area of Science:

• Pediatric Radiology
• Child Abuse Detection
• Forensic Imaging

Background:

• Infants and young children are most vulnerable to physical abuse.
• Fractures are present in over half of abused children, with rib fractures being common.
• Skeletal surveys are standard for screening children under 24 months.

Purpose of the Study:

• To outline imaging guidelines for suspected pediatric physical abuse.
• To emphasize the role of skeletal surveys and advanced imaging techniques.
• To highlight the importance of considering differential diagnoses.

Main Methods:

• Universal skeletal survey for children 24 months and younger.
• Repeat limited skeletal survey at 2 weeks for enhanced fracture detection and dating.
• Unenhanced head CT for suspected intracranial injury, including in asymptomatic infants.
• Contrast-enhanced CT of the abdomen/pelvis for suspected intra-abdominal/pelvic injuries.
• Adherence to American College of Radiology Appropriateness Criteria.

Main Results:

• Rib fractures may be the sole indicator in 30% of cases.
• Repeat surveys can identify additional fractures and provide dating information.
• Head CT is crucial for detecting occult abusive head trauma.
• Imaging choices depend on patient age, clinical presentation, and injury patterns.

Conclusions:

• Imaging protocols must be tailored to the individual child's presentation.
• Discrepancies between injury patterns and history warrant close scrutiny.
• Diagnosis requires differentiating abuse from other medical conditions.
• Evidence-based guidelines aid in appropriate imaging selection for child abuse evaluation.