Post-mortem imaging in suspected child physical abuse: a systematic review.

Area of Science:

• Forensic radiology
• Pediatric pathology
• Child abuse investigation

Background:

• Post-mortem (PM) imaging is increasingly used in pediatric forensic investigations.
• Evidence for its diagnostic yield in suspected child physical abuse requires synthesis and quality assessment.

Purpose of the Study:

• To review and synthesize current evidence on the diagnostic utility of PM imaging in suspected child physical abuse.
• To assess the quality of existing studies and identify challenges in the field.

Main Methods:

• A systematic review following PRISMA guidelines was conducted, searching databases until December 2024.
• Included original research with at least ten children undergoing PM imaging for suspected abuse.
• Data extraction and risk of bias assessment (ROBINS-I) were performed by experts; descriptive synthesis was used due to heterogeneity.

Main Results:

• Eighteen studies were included, utilizing PM radiography, PMCT, or PMMR.
• Most studies were retrospective with moderate-to-high risk of bias.
• PM imaging modalities detected subtle fractures and soft-tissue injuries, but correlation with autopsy findings is crucial.

Conclusions:

• PM imaging can reveal injuries missed during autopsy in child abuse cases.
• Standardized imaging protocols and larger prospective trials are essential to improve diagnostic accuracy and establish best practices.
• Current evidence is limited by study heterogeneity and bias, highlighting the need for higher-quality research.