Doubt, difficulties and practicalities in the diagnosis of non-accidental injury—a personal view

Abstract

Non-accidental injury (NAI) should be considered when children present with unexplained injuries. Multiple unexplained rib fractures, classic metaphyseal lesions and complex skull fractures (without a history of severe trauma) have a high specificity for abuse. Single long bone and skull fractures occur commonly in the non-accidentally injured child. Scintigraphy may be helpful in confirming the presence of significant abnormality when the initial radiographic abnormality is subtle. Abdominal injuries are easily overlooked in children presenting with skeletal or soft tissue manifestations of NAI. The differential diagnosis of abnormalities thought to be due to NAI should be considered carefully before reaching a conclusion that an injury has occurred non-accidentally. The skeletal survey should be performed by radiographers experienced in the examination of children in order to provide images of the highest quality.