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Occult Abdominal Trauma Screening in the Evaluation of Suspected Child Physical Abuse
Tagrid M Ruiz-Maldonado1, Joanne N Wood2, Antoinette L Laskey1
1The University of Utah, Department of Pediatrics, Center for Safe & Healthy Families, Primary Children's Hospital, Salt Lake City, Utah.
Insights
Routine transaminase screening for occult abdominal trauma (OAT) in suspected child abuse cases is often performed, but CT imaging is not. Low OAT prevalence suggests screening may not be necessary if abdominal injury signs are absent.
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse Pediatrics
- Radiology
Background:
- Occult abdominal trauma (OAT) screening with transaminases and abdominal CT is recommended for suspected physical abuse.
- Current practices and OAT prevalence in evaluated children are not well-defined.
Purpose of the Study:
- Evaluate case characteristics associated with OAT evaluation in young children.
- Determine OAT prevalence in children undergoing evaluation for suspected physical abuse.
Main Methods:
- Retrospective analysis of children younger than 60 months evaluated for suspected physical abuse.
- Exclusion of children with overt intra-abdominal injury signs.
- Logistic regression to identify factors associated with transaminase screening and CT imaging.
Main Results:
- Transaminase screening was performed in 64.6% of eligible children; 17.3% had elevated levels (>80 IU/L).
- Abdominal CT was performed in 43.4% of children with elevated transaminases.
- OAT was identified in 2.3% of children with elevated screening and 0.3% of all eligible children.
Conclusions:
- Transaminase screening is common, but CT imaging is less frequent despite elevated levels.
- Low OAT prevalence suggests routine screening may be unnecessary when abdominal injury signs are absent.
Background And Objectives:
Occult abdominal trauma (OAT) screening with transaminases, followed by abdominal computed tomography (CT) for transaminase values greater than 80 IU/L, has been recommended in cases of suspected physical abuse. This study aimed to evaluate case characteristics associated with OAT evaluation and determine OAT prevalence in these children.
Methods:
Injured children aged younger than 60 months undergoing Child Abuse Pediatrics (CAP) consultation for suspected physical abuse from February 2021 to May 2023 were identified in CAPNET, a multicenter research network. Children with symptoms or signs of intra-abdominal injury were excluded. We identified case characteristics associated with transaminase screening and abdominal CT imaging using logistic regression and determined OAT prevalence.
Results:
Of 6161 eligible children, 3982 (64.6%) underwent transaminase screening; 687/3982 (17.3%) had transaminases greater than 80 IU/L with 298/687 (43.4%) undergoing abdominal CT imaging. Variability in screening and imaging practices was identified between CAPNET sites. In a fully adjusted model, transaminase screening was associated with ages younger than 6 months, greater clinical severity, and site. CT imaging was associated with site, inpatient status, and higher transaminase range. We identified 16 OAT cases in children with transaminases greater than 80 IU/L, representing 2.3% of CAP-evaluated children with positive transaminase screening and 0.3% of all eligible children.
Conclusions:
Providers often perform transaminase screening but not abdominal CT imaging despite transaminases greater than 80 IU/L. The low prevalence of OAT suggests that routine transaminase screening in suspected child physical abuse evaluations may not be necessary when all signs and symptoms of abdominal injury are absent.
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