TY - JOUR
T1 - Yield of Neuroimaging in Infant Physical Abuse Evaluations
T2 - Do Infant Age and Injury Type Matter?
AU - Fingarson, Amanda K
AU - Fortin, Kristine
N1 - Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/8
Y1 - 2019/8
N2 - Background: Neuroimaging can be an important part of the medical workup for children with suspected physical abuse, but there are not specific guidelines on which children should undergo neuroimaging. Objective: We sought to evaluate the yield of neuroimaging in children <12 months of age who are undergoing physical abuse evaluations and to determine how the yield varied by age, injuries, and social risk factors. Methods: This was a retrospective observational study of infants who presented to an urban children's hospital between September 2007 and October 2012, were evaluated by the hospital's child abuse team, and who received skeletal surveys and underwent neuroimaging for suspected physical abuse. Infants who were diagnosed with head trauma before the abuse evaluation were excluded. Logistic regression was used to investigate the relationship between neuroimaging yield and patient age, presenting injury, and social features. Results: Head injuries were identified in 14 of 170 infants (8.2%). The yield was similar in children <6 months of age and children ≥6 months of age (7.5% and 9.4%, respectively; p = 0.674). Infants with bruises and cases involving a delay in seeking care or cases with previous Child Protective Services involvement were more likely to have injuries identified on neuroimaging. Infants with current or past neurologic signs/symptoms were also more likely to have head injuries on neuroimaging (5/17, 29%), although most infants with abnormal neuroimaging findings did not have neurologic signs/symptoms (9/14, 64%). Conclusions: We found that while certain features were associated with abnormal findings on neuroimaging, infant age (<6 months vs. 6-12 months) was not.
AB - Background: Neuroimaging can be an important part of the medical workup for children with suspected physical abuse, but there are not specific guidelines on which children should undergo neuroimaging. Objective: We sought to evaluate the yield of neuroimaging in children <12 months of age who are undergoing physical abuse evaluations and to determine how the yield varied by age, injuries, and social risk factors. Methods: This was a retrospective observational study of infants who presented to an urban children's hospital between September 2007 and October 2012, were evaluated by the hospital's child abuse team, and who received skeletal surveys and underwent neuroimaging for suspected physical abuse. Infants who were diagnosed with head trauma before the abuse evaluation were excluded. Logistic regression was used to investigate the relationship between neuroimaging yield and patient age, presenting injury, and social features. Results: Head injuries were identified in 14 of 170 infants (8.2%). The yield was similar in children <6 months of age and children ≥6 months of age (7.5% and 9.4%, respectively; p = 0.674). Infants with bruises and cases involving a delay in seeking care or cases with previous Child Protective Services involvement were more likely to have injuries identified on neuroimaging. Infants with current or past neurologic signs/symptoms were also more likely to have head injuries on neuroimaging (5/17, 29%), although most infants with abnormal neuroimaging findings did not have neurologic signs/symptoms (9/14, 64%). Conclusions: We found that while certain features were associated with abnormal findings on neuroimaging, infant age (<6 months vs. 6-12 months) was not.
KW - child abuse
KW - computed tomography
KW - craniocerebral trauma
KW - magnetic resonance imaging
KW - tomography
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U2 - 10.1016/j.jemermed.2019.03.041
DO - 10.1016/j.jemermed.2019.03.041
M3 - Article
C2 - 31171415
AN - SCOPUS:85066296534
SN - 0736-4679
VL - 57
SP - 195
EP - 202
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 2
ER -