Injuries in Children Undergoing Subspecialty Abuse Evaluations Because of Intimate Partner Violence

Intimate partner violence (IPV) and child physical abuse often co-occur, but the frequency and risk factors for abusive injuries in IPV-exposed children remain unknown. Our objectives were to (1) determine frequency of skeletal surveys (SSs) and neuroimaging use because of IPV and their diagnostic value in children aged less than 24 months evaluated by a child abuse pediatrics specialist (CAP) and (2) identify factors associated with performance of and findings on SS and neuroimaging.

We conducted a retrospective study of children aged less than 24 months undergoing CAP consultations because of IPV exposure from February 2021 to February 2024 in a multicenter child abuse research network. We analyzed use of SS and neuroimaging and associations between imaging use and sociodemographic factors and associations between imaging positivity and clinical factors (age, injury-related chief complaint, presenting trauma history, injury on physical examination).

Among 326 children, 305 (93.6%) underwent SSs, with 29 (9.5%) positive for a new fracture. Among 267 children without signs/symptoms of head trauma, 110 (41.2%) had neuroimaging, with 7 (6.4%) positive for intracranial injury. There was no disproportionality in SS use, but race/ethnicity and insurance type were associated with the use of neuroimaging. The presence of an injury on physical examination finding was associated with newly identified fractures (15.7% vs 6.4%; P = .009).

Current evidence supports use of SSs in children aged less than 24 months undergoing medical evaluations after exposure to IPV. Further research is needed to assess risk factors for positive findings on SSs and neuroimaging with larger sample sizes.