ACR Appropriateness Criteria® Suspected Physical Abuse-Child: Update 2025

Area of Science:

• Pediatric Radiology
• Forensic Imaging
• Child Abuse Detection

Background:

• Suspected physical abuse in children requires prompt and accurate diagnostic imaging.
• Imaging guidelines vary based on the child's age and clinical presentation.
• Identifying occult injuries is critical for diagnosis and intervention.

Purpose of the Study:

• To outline appropriate imaging strategies for suspected physical abuse in infants and children.
• To detail the role of various imaging modalities in detecting fractures and internal injuries.
• To emphasize evidence-based guidelines for pediatric forensic imaging.

Main Methods:

• Review of American College of Radiology Appropriateness Criteria.
• Application of GRADE methodology for evidence evaluation.
• Utilizing the RAND/UCLA Appropriateness Method for clinical scenarios.
• Expert consensus for cases with limited literature.

Main Results:

• Skeletal surveys and noncontrast head CT are first-line for infants (<24 months) to detect occult fractures and intracranial hemorrhages.
• For older children (>24 months), imaging is targeted, with skeletal surveys used selectively.
• Contrast-enhanced abdominal CT is recommended for suspected visceral injuries.
• Repeat skeletal surveys can identify healing injuries.

Conclusions:

• Age-specific imaging protocols are essential for evaluating suspected child abuse.
• Noncontrast head CT and skeletal surveys are fundamental for early detection of injuries.
• Imaging guidelines aid in the appropriate and timely diagnosis of physical abuse in pediatric patients.