
Findings in Child Abuse Reena Desai, MIV
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…
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
Diagnostic imaging • Skeletal survey • CT • MRI • Bone Scan
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
Bone Injuries • Low specificity: Subperiosteal new bone formation, clavicular fractures, long bone shaft fractures, and linear skull fractures
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
Skeletal Survey • Appendicular Skeleton • Humeri (AP) • Forearms (AP) • Hands (Oblique and PA) • Femurs (AP) • Lower Legs (AP) • Feet (AP)
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
8 mo. old infant presenting to ED with history of having fallen from changing table
20 mo. Infant presenting with shoulder pain who wouldn’t move arm
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
7 mo. old infant presenting with seizures and loss of consciousness
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.