Comparison of clinical and abdominal CT imaging findings in children evaluated for abusive and accidental abdominal trauma

Background: Diagnosis of child abuse in children evaluated for a blunt abdominal trauma can be challenging due to overlapping types of injuries.

Objective: Identify clinical characteristics and CT findings that differentiate children evaluated for accidental abdominal trauma (AcAT) and abusive abdominal trauma (AbAT).

Materials and methods: Retrospective (1/2010 to 6/2024) study on children < 3 years-old who had an abdominal CT scan for AcAT or AbAT. Demographic, clinical, and imaging variables were compared between CT-positive child abuse, and accidental trauma.

Results: Abdominal CT positive for trauma was found in 26.5% (82/309) children that were evaluated for AAT and in 28.8% (42/146) for AcAT. Children with positive CT for AbAT were significantly younger (average age 0.9 ± 0.9 versus 1.8 ± 0.9 years), and most (70.7%) were younger than one year old. Most children evaluated for AbAT with positive CT (70.7%) had an unknown cause of injury. The most common mechanism provided for abused children was low height fall (18/82, 22.0%) as compared with no low height fall in accidental trauma (p < 0.001). Rib fractures were identified on CT in 5049/82 children (61.059.8%) evaluated for AbAT as compared with 4/42 (9.5%) in children evaluated for AcAT (p < 0.001).

Conclusion: In children evaluated for blunt abdominal trauma, presence of rib fractures should alert radiologists to the possibility of child abuse. Abused children were mostly younger than one year, with an unknown mechanism of injury or a fall from a low height.