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Updated: Jun 26, 2026
Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure
Published on: July 30, 2009
Neuroimaging disagreements and consequences among pediatric transfers with concern for abuse
Kristi K Westphaln1, Elisabeth M W Figueroa2, Karen Kay Imagawa3
1University of California Los Angeles Joe C. Wen School of Nursing, Los Angeles, CA, United States of America; Children's Hospital of Los Angeles, Los Angeles, CA, United States of America.
Insights
Pediatric neuroradiologists are essential for accurate interpretation of head imaging in suspected child abuse cases. Disagreements with non-specialists significantly impact diagnosis and management.
Area of Science:
- Pediatric radiology
- Neuroradiology
- Child abuse imaging
Background:
- Previous studies show interpretation differences between pediatric and non-pediatric radiologists.
- Limited data exists on these differences specifically in child abuse cases.
Purpose of the Study:
- To compare head CT and MRI interpretations by community/adult radiologists versus academic pediatric neuroradiologists.
- To assess the impact of interpretation discrepancies on child abuse evaluations.
Main Methods:
- Retrospective analysis of 100 children under 6 years old with suspected abuse.
- Compared interpretations from community/adult radiologists and pediatric neuroradiologists.
- Analyzed agreement, disagreement types (major/minor), and consequences.
Main Results:
- 33% of interpretation pairs showed disagreement.
- Major disagreements included missed skull fractures (53%) and intracranial hemorrhages (30%).
- Disagreements altered clinical diagnosis and/or management in 68 cases.
Conclusions:
- Access to pediatric-trained neuroradiologists is crucial for accurate interpretation in suspected child abuse.
- Minimizing interpretation errors reduces adverse consequences for patients and healthcare systems.
- Specialized expertise is vital for child abuse evaluations involving neuroimaging.
Background:
Previous research supports substantial differences between pediatric neuroimaging interpretations by non-pediatric and pediatric-trained radiologists, however little is known about how this applies within the context of child abuse.
Objective:
Compare interpretations of head computed tomography and magnetic resonance imaging studies between community/adult academic radiologists and academic pediatric neuroradiologists.
Participants And Setting:
Children less than 6 years old with concern for abuse who were transferred from an outside hospital to a pediatric level I trauma center.
Methods:
This retrospective secondary analysis of data extracted from radiology and electronic health records used descriptive statistics to examine sample characteristics, imaging interpretation analysis (agreement, minor/major disagreement), and consequences of disagreements.
Results:
The analytic sample consisted of 100 cases of children less than 1 year old (76%) who underwent neuroimaging studies including computed tomography (n = 98) and magnetic resonance imaging scans (n = 2). Comparative analysis of neuroradiology interpretations demonstrated 67 pairs in agreement and 33 in disagreement. Of the 33 pairs in disagreement, 89 individual disagreements represented major (53%) and minor (47%) disagreements. Common major disagreements involved missed skull fractures (38.3%) and missed intracranial hemorrhages (30%), whereas common minor disagreements involved missed scalp swelling (38%) and incorrect skull fracture diagnosis (26%). Sixty-eight instances of disagreement altered clinical diagnosis and/or management related to child abuse evaluations.
Conclusions:
Given the critical clinical and investigative implications surrounding concern for child abuse, access to experienced pediatric-trained neuroradiologists is essential in minimizing interpretation errors and reducing consequences for patients, providers, and health care organizations.
