Karmazyn Boaz, Fisher Reid S, Alcaide Doriann M, Thompson Shannon L, Santos Rebeca, Jennings Gregory S, Eckert George J, Marine Megan B
Riley Hospital for Children at IU Health, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 705 Riley Hospital Dr., Rm 1053, Indianapolis, IN, 46202, USA.
Indiana University School of Medicine, 340 W 10th St, Indianapolis, IN, 46202, USA.
Emerg Radiol. 2025 Feb;32(1):23-31. doi: 10.1007/s10140-024-02305-2. Epub 2024 Dec 21.
Diagnosis of child abuse in children evaluated for a blunt abdominal trauma can be challenging due to overlapping types of injuries.
Identify clinical characteristics and CT findings that differentiate children evaluated for accidental abdominal trauma (AcAT) and abusive abdominal trauma (AbAT).
Retrospective (1/2010 to 6/2024) study on children < 3 years-old who had an abdominal CT scan for AcAT or AbAT. Demographic, clinical, and imaging variables were compared between CT-positive child abuse, and accidental trauma.
Abdominal CT positive for trauma was found in 26.5% (82/309) children that were evaluated for AAT and in 28.8% (42/146) for AcAT. Children with positive CT for AbAT were significantly younger (average age 0.9 ± 0.9 versus 1.8 ± 0.9 years), and most (70.7%) were younger than one year old. Most children evaluated for AbAT with positive CT (70.7%) had an unknown cause of injury. The most common mechanism provided for abused children was low height fall (18/82, 22.0%) as compared with no low height fall in accidental trauma (p < 0.001). Rib fractures were identified on CT in 5049/82 children (61.059.8%) evaluated for AbAT as compared with 4/42 (9.5%) in children evaluated for AcAT (p < 0.001).
In children evaluated for blunt abdominal trauma, presence of rib fractures should alert radiologists to the possibility of child abuse. Abused children were mostly younger than one year, with an unknown mechanism of injury or a fall from a low height.
对于因钝性腹部创伤接受评估的儿童，由于损伤类型重叠，虐待儿童的诊断可能具有挑战性。
确定区分因意外腹部创伤（AcAT）和虐待性腹部创伤（AbAT）接受评估的儿童的临床特征和CT表现。
对2010年1月至2024年6月期间因AcAT或AbAT进行腹部CT扫描的3岁以下儿童进行回顾性研究。比较CT阳性虐待儿童与意外创伤儿童的人口统计学、临床和影像学变量。
在因AAT接受评估的儿童中，26.5%（82/309）腹部CT创伤阳性；在因AcAT接受评估的儿童中，28.8%（42/146）阳性。AbAT的CT阳性儿童明显更年幼（平均年龄0.9±0.9岁对1.8±0.9岁），且大多数（70.7%）小于1岁。大多数CT阳性的AbAT评估儿童（70.7%）损伤原因不明。与意外创伤中无低高度坠落情况相比，虐待儿童最常见的机制是低高度坠落（18/82，22.0%）（p<0.001）。在因AbAT接受评估的82名儿童中，50/82（61.0%）CT发现肋骨骨折，而因AcAT接受评估的儿童中4/42（9.5%）有肋骨骨折（p<0.001）。
在因钝性腹部创伤接受评估的儿童中，肋骨骨折的存在应提醒放射科医生注意虐待儿童的可能性。受虐待儿童大多小于1岁，损伤机制不明或为低高度坠落。
