The abused child: a radiological reappraisal.

TLDR

Diagnostic imaging of the skeleton has limited sensitivity for detecting abuse-related injuries in children. The study proposes a more effective radiological evaluation strategy guided by clinical presentation. Only about one‑third of abused children exhibit skeletal trauma, such findings are rare after age two, fractures almost always coincide with clinical abuse evidence, and specific radiographic signs are uncommon and confined to infants.

Abstract

Radiological findings in 563 abused infants and children who were studied retrospectively emphasize the limitations of diagnostic imaging, specifically radiographic examination of the skeleton. Skeletal trauma was detected in less than one-third of all patients and was uncommon beyond two years of age. Fractures were rarely present without clinical evidence of physical abuse. Radiographic features considered specific for child abuse (epiphyseal-metaphyseal, rib fractures) or highly suggestive (occult, multiple/repetitive fractures) were distinctly infrequent and limited to infancy. A more efficacious approach to radiological evaluation based on clinical presentation is offered.