CT identification of abdominal injuries in abused pre-school-age children.
BACKGROUND
Although the abdominopelvic CT findings of abdominal trauma in children have been described, little has been written about the subset of children who are victims of abuse.


OBJECTIVE
Our purpose is to describe abdominopelvic injuries in abused pre-school-age children as identified on CT.


METHODS
An IRB-approved retrospective review of our institutional child abuse registry was performed. Searching a 14-year period, we identified 84 children ≤ 5 years of age with medically diagnosed abuse who underwent CT. We reviewed imaging studies, operative reports, autopsy findings and patient outcomes. Consensus review of the CT examinations was performed by CAQ-certified pediatric radiologists, and findings were categorized as normal or by injury types (solid organ versus bowel). The injuries were analyzed in light of existing literature on pediatric accidental and non-accidental injuries.


RESULTS
Of the 84 children, 35 (41.7%) had abdominal injuries. Abdominal injuries included liver (15), bowel (13), mesentery (4), spleen (6), kidneys (7), pancreas (4) and adrenal glands (3). Of these children, 26% (9/35) required surgical intervention for bowel, mesenteric and pancreatic injuries. Another 9/35 children died, not as a result of abdominal injuries but as a direct result of inflicted intracranial injuries.


CONCLUSIONS
Our data indicate that abdominal injuries in abused children present in a pattern similar to that of children with accidental abdominal trauma, underscoring the need for vigilance and correlative historical and clinical data to identify victims of abuse. Mortality in abused children with intra-abdominal injury was frequently related to concomitant head injury.
Department of Radiology and Radiological Sciences, Vanderbilt Children's Hospital, Nashville, TN 37232-9700, USA. m.hilmes@vanderbilt.edu
Melissa A
MA
Hilmes
Marta
M
Hernanz-Schulman
Christopher S
CS
Greeley
Lisa M
LM
Piercey
Chang
C
Yu
J Herman
JH
Kan
D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000401:mortality; D016009:Chi-Square Distribution; D002649:Child Abuse / Q000401:mortality; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D011860:Radiography, Abdominal; D012042:Registries; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed