Head computed tomography in suspected physical abuse: time to rethink?

Area of Science:

• Pediatric Radiology
• Child Abuse Detection
• Neuroimaging

Background:

• National guidelines recommend CT scans for children under one year with suspected physical abuse.
• CT scans are also considered for children under two to rule out abusive head trauma.

Purpose of the Study:

• To assess adherence to CT scan guidelines in young children with suspected abuse.
• To analyze the relationship between clinical presentation and CT findings.
• To refine diagnostic guidance for abusive head trauma.

Main Methods:

• Retrospective review of medical records for children under two years old assessed for suspected abuse between 2009 and 2017.
• Evaluation of CT scan frequency and diagnostic yield for intracranial injury or skull fracture.

Main Results:

• CT scans were performed in 60.3% of infants under 12 months and 7.8% of those aged 12-24 months.
• Diagnostic yield was highest in infants under 6 months (27.1%) and those aged 12-24 months (42.6%).
• Head swelling (OR 46.7) and neurological impairment (OR 20.6) were strong predictors of abnormal CT scans.

Conclusions:

• CT scans are indicated for children under two with suspected abuse, particularly those exhibiting head swelling or neurological impairment.
• MRI may be a suitable alternative for neurologically stable infants to minimize radiation exposure, provided expertise is available.