"When all cases of child abuse and neglect are studied, the incidence of physical evidence documented by diagnostic imaging studies is relatively small. However, imaging studies are often critical in the assessment of infant and young child with evidence of physical injury, and they also may be the first indication of abuse in a child who is seen with an apparent natural illness," the authors wrote.

"When viewed in conjunction with clinical and laboratory studies, imaging findings commonly provide support for allegations of abuse. For severely abused infants, the imaging findings alone may form the basis for a diagnosis of the inflicted injury."

Some key points from the policy are:
· In general, the radiographic skeletal survey is the method of choice for global skeletal imaging in cases of suspected abuse. According to the American College of Radiology, imaging systems used for suspected abuse of infants should have a spatial resolution of at least 10 line pairs per millimeter and a speed of no more than 200.
· Once the appropriate imaging system is chosen, a precise protocol for skeletal imaging must be developed to ensure consistent quality.
· When performed by staff experienced with paediatric nuclear imaging, skeletal scintigraphy may offer an alternative or an adjunct to the radiographic skeletal survey in selected cases, particularly in children aged older than 1 year.
· The skeletal survey is mandatory in all cases of suspected physical abuse in children aged younger than 2 years. The screening skeletal survey or bone scan has little value in children aged older than 5 years. Patients aged 2 to 5 years must be handled individually.
· All infants and children with suspected intracranial injury must undergo cranial CT or MRI, or both.
· Thoracoabdominal trauma in abused children should be evaluated and managed similar to accidental trauma.

"Abuse should be suspected and appropriate investigations initiated when the injury, clinical history, or the findings on the diagnostic imaging studies suggest the possibility of child abuse or nonaccidental injury," the authors concluded.

The revised statement is available here: http://pediatrics.aappublications.org/cgi/reprint/105/6/1345


SOURCE: American Academy of Pediatrics

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