Yield of Neuroimaging in Infant Physical Abuse Evaluations: Do Infant Age and Injury Type Matter?

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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. We sought to evaluate the yield of neuroimaging in children <12months of age who are undergoing physical abuse evaluations and to determine how the yield varied by age, injuries, and social risk factors. 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. Head injuries were identified in 14 of 170 infants (8.2%). The yield was similar in children <6months of age and children ≥6months 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%). We found that while certain features were associated with abnormal findings on neuroimaging, infant age (<6months vs. 6-12months) was not.