Yield of injury testing for contacts of children evaluated for physical abuse

Area of Science:

• Pediatric medicine
• Child abuse and neglect
• Forensic pediatrics

Background:

• Siblings and household contacts of physically abused children face elevated risks of abuse and potential, non-apparent injuries.
• Current recommendations for injury testing in these contact children are not standardized and remain a subject of debate.

Purpose of the Study:

• To document the current practices and diagnostic yield of injury testing in contact children exposed to physical abuse.
• To analyze the incidence of injuries detected through skeletal surveys and neuroimaging in this vulnerable population.

Main Methods:

• A cross-sectional study was conducted involving children under 10 years old evaluated for physical abuse across 10 US pediatric centers.
• Data were collected on the proportion of contact children undergoing skeletal surveys (SS) and neuroimaging.
• The study also reported the proportion of these tests that successfully identified injuries.

Main Results:

• Out of 6256 index abuse evaluations, 4863 contacts were identified. Among 316 contacts under 24 months with high concern for abuse, 62% had a skeletal survey, revealing fractures in 20 children.
• Skeletal survey completion was higher for twins, infants under 12 months, and those with physical exam findings.
• Neuroimaging in 123 contacts under 12 months with high abuse concern identified intracranial hemorrhage in 5 cases, all of whom were twins.

Conclusions:

• Injuries were more frequently identified in twins and younger contacts when skeletal surveys and neuroimaging were performed.
• Findings suggest that targeted injury testing, particularly skeletal surveys and neuroimaging, is crucial for specific contact groups, including twins and infants.
• The study underscores the importance of considering age and specific risk factors like being a twin when evaluating contacts of physically abused children.