Health
Radiologists, pediatricians urged to team up to find child abuse
■ A revised AAP policy statement says imaging studies are particularly important when screening very young children.
By Victoria Stagg Elliott — Posted May 5, 2009
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Physicians who care for children should work closely with those who perform imaging studies of various injuries in order to diagnose physical abuse correctly, according to an American Academy of Pediatrics policy statement published in the May Pediatrics.
"This approach will help ensure that child abuse is accurately identified and reliably differentiated from conditions that may simulate abuse," wrote members of the organization's section on radiology.
The authors also recommended that imaging studies be viewed in conjunction with clinical and laboratory investigations and say such information is particularly critical when evaluating infants and very young children. Full skeletal surveys are mandatory for those younger than 2 who are suspected of being physically abused and should be considered for those ages 2-5. Cranial computed tomography, magnetic resonance imaging or both can be considered for those with head injuries. The paper also cautioned that, although imaging may provide the first clues that a child is being abused, it may also suggest other possible diagnoses.
"I think [the paper] is an excellent attempt to try to improve the science of diagnosing child abuse. You want to be sure that you're truly on the right track. I don't want to minimize child abuse, but you want to be sure that, for a very emotional issue, you are accurate in the assessment," said Robert W. Stuart, MD, medical director of urgent care for Aurora Medical Group in Milwaukee. He is not affiliated with the authors.
This document also advocated that as little ionizing radiation as possible be used but added that low-resolution scans will usually not be sensitive enough to pick up some of the skeletal abnormalities caused by physical abuse. High-detail scans should be utilized.
Physicians working on violence and abuse issues stressed, however, that this technology finds evidence only of physical abuse and hope that awareness of the other forms will increase.
"We would like to have everybody fully aware of all forms of abuse and be able to diagnose it," said David McCollum, MD, board chair of the Academy on Violence and Abuse.
The last AAP policy statement on this subject was issued in June 2000.
