Abstract
Background
Incomplete history and concern for occult injury in suspected child abuse occasionally results in CT screenings of the abdomen and pelvis. At our institution, we noted that these exams were infrequently positive.
Objective
To identify clinical or laboratory criteria that may predict intra-abdominal injury and guide the use of abdominal and pelvic CT in this population.
Materials and methods
This retrospective review involved 68 children older than 36 months who had a CT of the abdomen/pelvis for suspected abuse. CT results and patient charts were reviewed for physical exam and historical and laboratory variables.
Results
CTs were positive in 16% of patients (11/68). Hypoactive/absent bowel sounds (P = 0.01, specificity = 94.7%) and AST and ALT values greater than twice normal (P = 0.004 and P = 0.003 respectively, NPV = 93.6%) were significantly associated with positive CTs. Multiple abnormal physical exam or laboratory findings were also significantly associated with positive CTs (P = 0.03 and P = 0.002 respectively, specificity = 91.3% and NPV = 93.6% respectively).
Conclusion
CTs of the abdomen and pelvis are infrequently positive in cases of suspected abuse. To reduce radiation exposure, CTs should only be ordered if there are findings indicating that they may be positive. In our population, these findings include absent/hypoactive bowel sounds, LFTs greater than twice normal and ≥2 abnormal labs or physical exam findings.
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References
DiScala C, Sege R, Li G et al (2000) Child abuse and unintentional injuries: a 10-year retrospective. Arch Pediatr Adolesc Med 154:16–22
Kirks DR (1983) Radiological evaluation of visceral injuries in the battered child syndrome. Pediatr Ann 12:888–893
Lindberg D, Makoroff K, Harper N et al (2009) Utility of hepatic transaminases to recognize abuse in children. Pediatrics 124:509–516
Ledbetter DJ, Hatch EI Jr, Feldman KW et al (1988) Diagnostic and surgical implications of child abuse. Arch Surg 123:1101–1105
Cooper A, Floyd T, Barlow B et al (1988) Major blunt abdominal trauma due to child abuse. J Trauma 28:1483–1487
Trokel M, Discala C, Terrin NC et al (2006) Patient and injury characteristics in abusive abdominal injuries. Pediatr Emerg Care 22:700–704
Sivit CJ, Taylor GA, Eichelberger MR (1989) Visceral injury in battered children: a changing perspective. Radiology 173:659–661
Wood J, Rubin DM, Nance ML et al (2005) Distinguishing inflicted versus accidental abdominal injuries in young children. J Trauma 59:1203–1208
Gaines BA, Shultz BS, Morrison K et al (2004) Duodenal injuries in children: beware of child abuse. J Pediatr Surg 39:600–602
Touloukian RJ (1969) Battered children with abdominal trauma. GP 40:106–109
Hennes HM, Smith DS, Schneider K et al (1990) Elevated liver transaminase levels in children with blunt abdominal trauma: a predictor of liver injury. Pediatrics 86:87–90
Oldham KT, Guice KS, Kaufman RA et al (1984) Blunt hepatic injury and elevated hepatic enzymes: a clinical correlation in children. J Pediatr Surg 19:457–461
Karaduman D, Sarioglu-Buke A, Kilic I et al (2003) The role of elevated liver transaminase levels in children with blunt abdominal trauma. Injury 34:249–252
Bowkett B, Kolbe A (1998) Traumatic duodenal perforations in children: child abuse a frequent cause. Aust N Z J Surg 68:380–382
Kleinman PK, Raptopoulos VD, Brill PW (1981) Occult nonskeletal trauma in the battered-child syndrome. Radiology 141:393–396
McCort J, Vaudagna J (1964) Visceral injuries in battered children. Radiology 82:424–428
Nimkin K, Teeger S, Wallach MT et al (1994) Adrenal hemorrhage in abused children: imaging and postmortem findings. AJR 162:661–663
Touloukian RJ (1968) Abdominal visceral injuries in battered children. Pediatrics 42:642–646
Fossum RM, Descheneaux KA (1991) Blunt trauma of the abdomen in children. J Forensic Sci 36:47–50
Coant PN, Kornberg AE, Brody AS et al (1992) Markers for occult liver injury in cases of physical abuse in children. Pediatrics 89:274–278
Ruess L, Sivit CJ, Eichelberger MR et al (1997) Blunt abdominal trauma in children: impact of CT on operative and nonoperative management. AJR 169:1011–1014
Oldham KT, Guice KS, Ryckman F et al (1986) Blunt liver injury in childhood: evolution of therapy and current perspective. Surgery 100:542–549
Acknowledgement
Michigan Institute for Clinical and Health Research (MICHR) grant: UL1RR024986.
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Trout, A.T., Strouse, P.J., Mohr, B.A. et al. Abdominal and pelvic CT in cases of suspected abuse: can clinical and laboratory findings guide its use?. Pediatr Radiol 41, 92–98 (2011). https://doi.org/10.1007/s00247-010-1847-8
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DOI: https://doi.org/10.1007/s00247-010-1847-8