Variability in Occult Injury Screening Among Siblings/Household Contacts of Physical Abuse Victims

Area of Science:

• Pediatric Emergency Medicine
• Child Abuse and Neglect
• Radiology

Background:

• Abusive head trauma is a leading cause of death in infants.
• Radiologic screening is recommended for young children exposed to potential abuse.
• Limited data exists on the yield of these screenings in at-risk contacts.

Purpose of the Study:

• To evaluate the performance and yield of radiologic screening for occult injuries in child contacts.
• To identify factors influencing the decision to defer screening in these cases.

Main Methods:

• Retrospective chart review of children under 8 years old presenting for evaluation.
• Data collected on demographics, radiologic findings, physical exams, and psychosocial assessments.
• Descriptive statistics and chi-squared analysis were used.

Main Results:

• 390 contacts were identified; 93.3% were siblings.
• Neuroimaging in infants showed no abnormalities.
• Skeletal surveys in children under 2 years old had a 9% abnormality rate, with some refuted by follow-up.
• Deferred imaging reasons included child's appearance and caregiver concerns.

Conclusions:

• Screening evaluations, including physical exams and imaging, can identify abuse concerns.
• Further research is needed on factors affecting radiologic screening decisions.
• Standardized coding and prospective studies are recommended for better epidemiologic research.