1. Findings in Child Abuse Reena Desai, MIV

2. Child Abuse • Includes physical, sexual, emotional abuse, and neglect • Nearly 1.4 million children are victimized each yr. 160,000 suffer from serious injuries and 1200 children die each yr. • Risk factors include the following: low income households, mutiple children, single mother, etc…

3. H&P red flags • Most common injuries include bruises, bites, burns, fractures, head trauma, and abdominal trauma • Story of injury inconsistent with physical findings • Unexplained injuries to buttocks, thighs, torso, ears, and neck • Lesions in various stages of healing

4. Diagnostic imaging • Skeletal survey • CT • MRI • Bone Scan

5. Bone Injuries • High specificity : Fractures to metaphysis, posterior ribs, scapula, spinous process, and sternum • Moderate specificity: Mult. Fractures, fractures of different ages, epiphyseal separations, vertebral body fractures and subluxations, digital fractures, complex skull fractures

6. Bone Injuries • Low specificity: Subperiosteal new bone formation, clavicular fractures, long bone shaft fractures, and linear skull fractures

7. Tools to evaluate Bone injuries Up to 2 yrs of age- skeletal survey w/ follow up survey in two weeks w/ possible bone scan. 5+ yrs.- Radiographs based on clinical findings

8. Skeletal Survey • Appendicular Skeleton • Humeri (AP) • Forearms (AP) • Hands (Oblique and PA) • Femurs (AP) • Lower Legs (AP) • Feet (AP)

9. Skeletal Survey • Axial Skeleton • Thorax (AP and lateral), to include thoracic spine and ribs • Abdomen, lumbosacral spine, and bony pelvis (AP) • Lumbar spine (lateral) • Cervical Spine (lateral) • Skull (frontal and lateral) • AP = anteroposterior;  PA = posteroanterior

10. Metaphyseal Fractures

11. Tibia Bucket Handle fracture

12. Posterior rib fractures

14. Multiple Fractures

15. 8 mo. old infant presenting to ED with history of having fallen from changing table

16. Humeral Shaft Fracture

17. 20 mo. Infant presenting with shoulder pain who wouldn’t move arm

20. Skull/ Brain injuries • Skeletal survey to show skull fractures • CT w/o contrast for acute injuries • MRI is more sensitive than CT for detecting contusions, traumatic venous thrombosis, and older injuries • Common injuries include cerebral contusions and subdural hematomas

21. Cerebral Edema

22. 7 mo. old infant presenting with seizures and loss of consciousness

26. Abdominal Injuries • Commonly caused by blunt trauma • Use CT first • Other follow up studies may be necessary • Common injuries include hematomas of the duodenum and jejunum • Other injuries include liver lacerations and pancreatitis.

27. Liver injury

28. Duodenal Hematoma