CT head and MRI head CT or MRI of the head should also be performed in children with neurologic symptoms or risk factors for intracranial injuries (see variant 3). CT of the abdomen and pelvis Nonskeletal injuries to the chest, abdomen, and pelvis can occur as the result of child abuse. Child abuse should be considered in any child with thoracoabdominal injuries that are not consistent with the provided history. Up to 10% of abused children have intra-abdominal injury [49]; 15% of children aged 0 to 4 years hospitalized for abdominal injury are victims of child abuse [70,71]. Victims of nonaccidental abdominal trauma tend to be younger and have a more delayed presentation than those who experience accidental trauma [72]. Clinical findings of abdominal pain, abdominal distension, vomiting, abdominal wall bruising, and hypoactive or absent bowel sounds may suggest intra-abdominal injury [73-75]. Abnormal liver transaminases and pancreatic enzymes may be seen with occult abdominal trauma [74,75]. One series suggested that nearly half of abused children with abdominal injury require surgical intervention [76]. In addition, independent of concomitant injury, blunt trauma due to child abuse is associated with a 6-fold increase in odds of death compared to children whose injuries resulted from accidental trauma [70]. Nonskeletal abdominopelvic injuries include pancreatitis, pancreatic pseudocysts, and lacerations and contusions of the liver, adrenal gland, spleen, kidneys, and bowel (especially duodenum) [77,78]. Bowel injuries and pancreatic injuries are seen disproportionately more often in child abuse compared to accidental trauma [49]. Contrast-enhanced CT of the abdomen is indicated in acute evaluation of the child with suspected abdominopelvic injuries. The use of ultrasound in the acute setting is limited, as both focused abdominal scan in trauma and standard abdominopelvic ultrasound are less sensitive than CT in detection of hemoperitoneum and solid-organ injuries [79,80].
Suspected Physical Abuse Child. CT head and MRI head CT or MRI of the head should also be performed in children with neurologic symptoms or risk factors for intracranial injuries (see variant 3). CT of the abdomen and pelvis Nonskeletal injuries to the chest, abdomen, and pelvis can occur as the result of child abuse. Child abuse should be considered in any child with thoracoabdominal injuries that are not consistent with the provided history. Up to 10% of abused children have intra-abdominal injury [49]; 15% of children aged 0 to 4 years hospitalized for abdominal injury are victims of child abuse [70,71]. Victims of nonaccidental abdominal trauma tend to be younger and have a more delayed presentation than those who experience accidental trauma [72]. Clinical findings of abdominal pain, abdominal distension, vomiting, abdominal wall bruising, and hypoactive or absent bowel sounds may suggest intra-abdominal injury [73-75]. Abnormal liver transaminases and pancreatic enzymes may be seen with occult abdominal trauma [74,75]. One series suggested that nearly half of abused children with abdominal injury require surgical intervention [76]. In addition, independent of concomitant injury, blunt trauma due to child abuse is associated with a 6-fold increase in odds of death compared to children whose injuries resulted from accidental trauma [70]. Nonskeletal abdominopelvic injuries include pancreatitis, pancreatic pseudocysts, and lacerations and contusions of the liver, adrenal gland, spleen, kidneys, and bowel (especially duodenum) [77,78]. Bowel injuries and pancreatic injuries are seen disproportionately more often in child abuse compared to accidental trauma [49]. Contrast-enhanced CT of the abdomen is indicated in acute evaluation of the child with suspected abdominopelvic injuries. The use of ultrasound in the acute setting is limited, as both focused abdominal scan in trauma and standard abdominopelvic ultrasound are less sensitive than CT in detection of hemoperitoneum and solid-organ injuries [79,80].