Radiographic characteristics of skull fractures resulting from child abuse

TLDR

The study compared radiographic skull fracture features in 39 abused children with 95 accidental injury cases to identify distinguishing characteristics. The cohort comprised children under 2 years, and their ER and hospital records were reviewed. Clinical features alone cannot distinguish abuse from accidental injury, but multiple, bilateral, or suture‑crossing fractures are significantly more common in abuse and should raise suspicion.

Abstract

Radiographic characteristics of skull fractures in 39 cases of documented child abuse were compared with skull fractures in 95 cases of accidental injury to determine if differential features could be identified. All children were less than 2 years old. Emergency room and hospital records for these patients were also reviewed. The results of this study show that clinical features did not provide any clues as to whether the children had been injured by abuse or by accident. However, it was found that multiple fractures, bilateral fractures, and fractures crossing sutures occurred significantly more often in abuse cases than in accidental injury. When such fractures are present, abuse should be suspected.