Update to imaging guidelines for children with suspected abuse could cut radiation exposure
Though guidelines dictate a standard set of radiographic projections that should be collected in each case when a child presents to a hospital with suspected physical abuse, an update to those recommendations suggests a more fragmented method of imaging that could ultimately slash time and radiation exposure.
Michael Paddock, MSc, and a team of U.K.-based colleagues with the NHS Foundation Trust first published an update to 2008 guidelines last year, when they released a pictorial guide for dealing with suspected intentionally inflicted injuries in children. The authors covered fundamental considerations, the role of radiologists and how to attempt initial imaging and skeletal surveys in a young patient pool.
Skeletal surveys are a key part of the diagnostic process in these cases, Paddock et al. wrote—especially because they have the ability to flag occult bony injuries, identify predisposing medical conditions and help date fractures. And since any reported injuries could stem from illegal behavior, radiologists need to ensure scans are accurate and clear enough to be presented in a court of law.
Paddock and co-authors have held to their 2017 recommendation of obtaining a standard set of radiologic images for each patient, noting that the number and type of recommended projections now depend on the size of the child. Typically, “small children” are considered those under 1 year old, they wrote, while “large children” represent any older pediatric patients.
But, veering from their previous thoughts, the authors published a new suggestion this month: that if a child presents with a clinically suspected bony injury and good-quality diagnostic radiographs are taken upon that patient’s admission, that child can likely skip a full-body initial skeletal survey.
“This can reduce the length of the examination time in addition to the radiation burden which is advantageous for all involved,” Paddock and colleagues wrote in Clinical Radiology. “The latter is particularly important in the context of the initial SS, which may now comprise of up to 34 radiographic projections in a large child, including coned projections.”
The team still reinforced the urgency of having a consultant radiologist available at all stages of image examination, since they can assess the diagnostic quality of scans and determine whether any projections need to be repeated.
“It is important that readers using our pictorial reviews as references are aware of these specific changes to the imaging protocol when investigating suspected physical child abuse in their own departments,” the authors said. “We strongly encourage all involved in the care and investigation of these children to read and follow the updated guidance.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.