Clinical Report: Imaging Guidelines for Suspected Child Abuse Evaluation
Overview
This report summarizes key imaging recommendations from the European Society of Paediatric Radiology for suspected child abuse, emphasizing skeletal surveys and brain CT in infants under 1 year. It highlights the importance of follow-up imaging and MRI for neurological abnormalities, and details common injury patterns in abusive head trauma (AHT).
Background
Child abuse is a global issue with infants at highest risk, particularly for severe physical abuse. Abusive head trauma (AHT) is a leading cause of death in infants and toddlers under 2 years. Diagnosis relies on clinical history, examination, laboratory tests, and imaging. Imaging plays a central role due to often non-specific clinical presentations and the high stakes of accurate diagnosis.
Data Highlights
Incidence of AHT ranges from 14 to 53 per 100,000 children. Severe physical abuse is 120 times more common in infants than in children over 5 years. Follow-up skeletal surveys after 11–14 days improve sensitivity of initial imaging. Subdural haemorrhage is the most common intracranial injury pattern in AHT.
Key Findings
Initial imaging in children under 1 year with suspected abuse should include a skeletal survey and unenhanced brain CT with 3D reformats.
Follow-up limited skeletal survey after 11–14 days is mandatory to increase detection sensitivity.
Brain and whole spine MRI is recommended within 2–5 days if CT is normal but neurological signs or high suspicion persist.
Subdural haemorrhage, especially multifocal, bilateral, or interhemispheric, is strongly associated with AHT.
Complex, bilateral, or stellate skull fractures are more frequent in AHT but have low positive predictive value due to common accidental fractures.
Ligamentous injuries at the craniocervical junction and spinal subdural haemorrhages are important MRI findings favoring AHT.
Clinical Implications
Radiologists should follow standardized imaging protocols including initial skeletal surveys and brain CT in infants, with consideration of MRI for persistent neurological abnormalities. Recognizing specific injury patterns such as multifocal subdural haemorrhages and ligamentous injuries aids differentiation of abusive from accidental trauma. Accurate and detailed reporting is critical to guide multidisciplinary assessment and protect vulnerable children.
Conclusion
Adherence to these imaging guidelines enhances detection and characterization of abusive injuries in young children, supporting timely diagnosis and intervention. Multimodal imaging combined with clinical correlation remains essential in suspected child abuse cases.
References
European Society of Paediatric Radiology -- Key Imaging Guidelines for Evaluating Suspected Child Abuse
