Related Experiment Video
Updated: Jul 8, 2026
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Variation in Use of Neuroimaging in the Care of Infants Undergoing Subspecialty Evaluations for Abuse: A Multicenter
Emily Alpert1, Joanne N Wood2, Justine Shults3
1Perelman School of Medicine at the University of Pennsylvania (E Alpert), Philadelphia, Pa.
Insights
Hospital variation exists in neuroimaging for infants evaluated for physical abuse. Standardized guidelines are needed to ensure consistent care for suspected abusive head trauma evaluations.
Area of Science:
- Pediatric medicine
- Child abuse research
- Medical imaging
Background:
- Infants without overt head trauma signs undergoing abuse evaluations may receive neuroimaging.
- Variations in neuroimaging use can impact diagnosis and care.
Purpose of the Study:
- Quantify hospital-level variation in neuroimaging for infants evaluated for physical abuse.
- Assess disparities in neuroimaging based on race, ethnicity, and insurance.
Main Methods:
- Cross-sectional study of infants (<12 months) at 10 CAPNET sites.
- Included infants without overt intracranial injury signs undergoing skeletal surveys.
- Analyzed neuroimaging completion (CT/MRI) using multivariable logistic regression.
Main Results:
- 67% of 1114 infants received neuroimaging; hospital rates varied from 51% to 80%.
- Younger age, rib fractures, and hospital site were associated with neuroimaging.
- Race, ethnicity, and insurance type were not significant predictors.
Conclusions:
- Significant hospital-level variation in neuroimaging use was observed.
- Highlights the need for standardized guidelines in evaluating infants for abuse.
- Care standardization is crucial for infants undergoing abuse evaluations.
Objectives:
1) To quantify hospital-level variation in use of neuroimaging to screen for intracranial injury (ICI) among infants without overt signs or symptoms of head trauma undergoing subspecialty evaluations for physical abuse; 2) to assess for disproportionality in neuroimaging based on race and ethnicity and insurance type.
Methods:
This was a cross-sectional study of infants age <12 months receiving subspecialty child abuse evaluations from February 2021 to December 2022 at 10 sites in CAPNET, a multicenter child abuse research network. Infants were included if they underwent a skeletal survey and lacked overt signs of possible ICI or blunt head injury. Outcome was completion of neuroimaging (computed tomography [CT] or magnetic resonance imaging [MRI]). Multivariable logistic regression was used to assess associations between demographic, clinical, and hospital factors with neuroimaging use.
Results:
Of 1114 infants, 746 (67%) underwent neuroimaging ranging from 51% to 80% across CAPNET hospitals. In multivariable analysis, young age, presence of rib fracture(s), and site had significant associations with neuroimaging. Insurance type and race and ethnicity did not contribute significantly to the model. After adjustment for case-mix, there was significant variation across hospitals, with neuroimaging use ranging from 51% (95% CI: 43%, 59%) to 79% (95% CI 71%, 88%).
Conclusion:
We identified significant variation in neuroimaging use across CAPNET hospitals, highlighting the need for guideline development and care standardization during the care of infants undergoing abuse evaluations.
