Suspected Physical Abuse Flashcards
Who is the guidance set out by?
RCR and ScOR
RCPCH - the royal college of paediatrics and child health
What are the red flags to suspect physical abuse?
•No history
• inappropriate, inconsistent or implausible history
• conflicting
• Delay in presentation
• multiple injuries, different ages/ stages of healing, locations
3 common Types of injuries
Fractures - 2nd most common findings
Inter cranial injures - major cause of morbidity and mortality
Visceral injures - present later in time
What exams are required?
Skeletal survey <2years
skeletal survey plus ct head < 1
Children > 1 year with external evidence of head trauma or neurology -CT head
What is needed for a Skeletal survey?
Acquired and reported within 24 hours and no later than 72 hours
Performed 9-5 Monday to Friday
2trained paediatric radiographers to perform
Paediatric Rn or HCA must be present to assist with Immobilisation
Sedation can be used
What age is skeletal survey done?
Up to 2 years
Why do a follow up CXR?
To better visualise rib fractures
Neurological Imaging
Un- Enhanced CT with multi-planar reformats
MR head and spine day 2-6 if CT abnormal
CT should be considered in >1 if there are other injuries with high suspicion of abuse
Rib, spinal #, visceral trauma or retinal trauma
What is the protocol for a Deceased Child?
Postmortem imaging of whole body indicated in cases of SIDs
SS and CT head also completed
Whole body CT/MR if diagnosis in doubt
Which are the Low suspicion fracture areas?
-sub-periosteal new bone formation (SPNBF)
- Clavicle
- Shaft long-bone
- linear skull
Which are Moderate suspicion fracture locations?
+ multiple (especially bilateral)
+ different ages of healing fractures
+ Epiphyseal separations
+ vertebral bodies and subluxations
+ Digital fractures
+ complex skull fractures
Which are High suspicion fracture locations ?
~ Classical metaphysical lesions (CML)
~ rib fractures
~ scapular
~ spinous process
~ sternum
Mechanism of injuries vs injuries observed
Shaking, griping, twisting, pulling- metaphyseal injury
Gripping - sub Periosteal new bone formation
Direct blows or applied lever force - transverse fracture
Twisting - spiral fractures
Pulling - fracture separation
What injury does Shacking, twisting, gripping, pulling show?
Metaphyseal injury
What injury does Gripping show?
Subperiosteal new bone formation (SPNBF)
