If used in follow-up, radiographs of areas of abnormal uptake should also be performed. CT chest Low-dose noncontrast CT of the chest also offers a time advantage over repeat skeletal survey. It is useful in the detection of rib, scapula, and thoracic spine fractures not seen on skeletal survey [47]. Anterior and posterior rib fractures are detected more often by CT than by skeletal survey [46]. Fractures may also be dated as acute, subacute, or chronic [46,85]. It would not replace contrast-enhanced chest CT in initial evaluation of nonskeletal thoracic injuries, such as hemopericardium, cardiac contusions and lacerations, pleural effusion, and lung contusions [23,64,77,81]. CT head and MRI head Follow-up neuroimaging is usually not indicated in the setting of a negative skeletal survey and absence of clinical suspicion of AHT. If there is suspicion for injury after the initial evaluation, neuroimaging should be considered. Noncontrast CT is useful in the evaluation of healing skull fractures, whereas MRI is the method of choice to evaluate the intracranial compartment. Summary of Recommendations The appropriate imaging of pediatric patients being evaluated for suspected physical abuse depends upon the age of the child, the presence of neurological signs and symptoms, and evidence of visceral thoracic or abdominopelvic injuries. A skeletal survey is indicated in the initial imaging evaluation of a child 24 months of age or younger. In older children, it is usually appropriate to target imaging to the area(s) of suspected injury. Skeletal survey and CT head without contrast are indicated in the emergent/initial imaging evaluation of a child with neurologic signs and symptoms, complex skull fracture, apnea, multiple fractures, spine trauma, or facial injury. These examinations are not indicated for general screening. MRI head may provide additional diagnostic information to head CT in about 25% of children.
Suspected Physical Abuse Child. If used in follow-up, radiographs of areas of abnormal uptake should also be performed. CT chest Low-dose noncontrast CT of the chest also offers a time advantage over repeat skeletal survey. It is useful in the detection of rib, scapula, and thoracic spine fractures not seen on skeletal survey [47]. Anterior and posterior rib fractures are detected more often by CT than by skeletal survey [46]. Fractures may also be dated as acute, subacute, or chronic [46,85]. It would not replace contrast-enhanced chest CT in initial evaluation of nonskeletal thoracic injuries, such as hemopericardium, cardiac contusions and lacerations, pleural effusion, and lung contusions [23,64,77,81]. CT head and MRI head Follow-up neuroimaging is usually not indicated in the setting of a negative skeletal survey and absence of clinical suspicion of AHT. If there is suspicion for injury after the initial evaluation, neuroimaging should be considered. Noncontrast CT is useful in the evaluation of healing skull fractures, whereas MRI is the method of choice to evaluate the intracranial compartment. Summary of Recommendations The appropriate imaging of pediatric patients being evaluated for suspected physical abuse depends upon the age of the child, the presence of neurological signs and symptoms, and evidence of visceral thoracic or abdominopelvic injuries. A skeletal survey is indicated in the initial imaging evaluation of a child 24 months of age or younger. In older children, it is usually appropriate to target imaging to the area(s) of suspected injury. Skeletal survey and CT head without contrast are indicated in the emergent/initial imaging evaluation of a child with neurologic signs and symptoms, complex skull fracture, apnea, multiple fractures, spine trauma, or facial injury. These examinations are not indicated for general screening. MRI head may provide additional diagnostic information to head CT in about 25% of children.