Frequently Asked Questions About Child Injury Law
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Why is it important to use x-ray, or radiographic imaging, while evaluating a child for child abuse?
It is important to use imaging studies to identify present and past skeletal injuries that a victim of child abuse may have suffered. For infants and small children, health care providers may order skeletal surveys to identify past and present skeletal injuries. Health care providers may order a skeletal survey and then repeat the study again two weeks later. This is because acute fractures may be occult or missed on the first study, but then evidence of a healing occult or missed fracture may be found on the second skeletal survey.
High resolution images are used to avoid a missed diagnosis. Providers generally order multiple views of the chest including anterior and posterior with oblique views of the ribs, two skull views, lateral views of the entire spine, anterior and posterior views of the pelvis, arms, hands, legs, and feet. One x-ray view of any body part is not acceptable.
Evidence of child abuse is generally present when fractures are correlated clinically and found to involve the ends of long bones in non-ambulatory infants, multiple fractures or fractures in various phases of healing in any child, fractures associated with intracranial bleeds and depressed skull fractures.
Why do providers order bone scans (also known as bone scintigraphy)for children that are being evaluated for child abuse?
Healthcare providers may order bone scans (also known as bone scinitigraphy) to identify new fractures suspected to have occurred only hours previous to the study but are difficult to identify in certain anatomical locations. A bone scan is not used alone to evaluate the skeleton of a child abuse victim, but is used in conjunction with multiple imaging studies. If occult injuries are suspected, a bone scan may be ordered. Because follow-up skeletal surveys are often used, bone scans are not used as often.
Bone scans require relatively longer scanning times then x-ray studies and may not be possible due to the age or extent of injury to the child. It often requires that the child be sedated to obtain good quality studies. Other draw backs include higher radiation exposure then plain x-ray studies and higher cost for testing.
Why are CT scans used to evaluate children for injuries secondary to child abuse?
CT is generally considered a primary screening modality.
Computed tomography (CT) imaging is a very useful test for evaluating the skull and facial bones for fractures and the chest and abdomen for bone and soft tissue (organ) injuries. CT of the head without contrast may be ordered to evaluate for suspected head trauma in children. CT is useful to identify blunt trauma injuries to the chest, intestines, spleen and liver. CT imaging is a quick diagnostic tool. Drawbacks include missed small hemorrhages, hemotomas or fractures.
CT of the head should be utilized when the mechanism of injury may correlate with occult head injury and when physical examination indicates suspicion for head trauma. CT scans are often repeated to evaluate for evolving injury and infarction.
The American College of Radiology (ACR) recommends that children with neurological symptoms associated with suspected child abuse undergo CT evaluation. In children younger than two years of age, CT is recommended (by ACR) for children suspected to be victims of child abuse that have no focal or neurological signs and symptoms.
Why do healthcare providers order magnetic resonance imaging(MRI) for evaluating childrenfor child abuse injuries?
Magnetic resonance imaging is a very sensitive test for detecting soft tissue injuries and infarctions secondary to child abuse injuries. MRI offers greater detail and clarity than CT. If a CT study is questionable, MRI identifies more subtle injurious pathology. MRI is also very useful when neurological symptoms are more severe than that clinically correlated to CT scan. It is also a useful study to identify ligamentous injuries, especially when injury to the child's neck is strongly suspected.
Drawbacks of MRI include prolonged scanning time and necessity for sedation in young children. MRI is a very useful study during the post-injury phase approximately 3 days through 1 month later.
Why do healthcare providers order ultrasounds for children suspected of having child abuse injuries?
Ultrasound is a safe diagnostic tool with no radiation exposure. It is cost-effective and simple to perform. To evaluate the head of a child suspected of having head trauma, the victim must have an open anterior fontanelle. Ultrasound may indentify intracranial abnormalities, including cerebral edema, hemorrhage or ventricular enlargement. Ultrasound may also identify abdominal injuries involving bleeding and free fluid.
Ultrasound provides important but limited diagnostic information that may help guide the provider in child abuse evaluation.
Child abuse evaluation has important key features, what are they?
It is important to do a thorough physical examination with a thorough history of present illness and social history interview. The reported mechanism of injury or unwitnessed injury history are very important. The findings of the interview and examination must be clinically correlated with laboratory and radiographic findings.
What kind of bone fractures are present or indicative of child abuse?
There are types of bone fractures that are highly indicative of child abuse. But any type of fracture may be associated with child abuse injuries. A healthcare provider must always evaluate a child's injury in the context of the child's developmental stage. For instance, non-ambulatory children and infants rarely fracture a bone accidentally. Therefore, it is important to correlate clinical evidence, the type and distribution of associated injuries, the developmental stage of the child with the type of fracture. Because the force required to induce fracture exceeds the force of a simple fall.
Fractures are described according to their anatomical location and characteristic features.
Fractures highly suggestive of child abuse include sternal fractures, scapular fractures, posterior rib fractures, metaphyseal fractures (corner, bucket-handle fractures) and spinous process fractures.
Healthcare providers should automatically consider a child at high-risk for child abuse when parents or caregivers report unwitnessed injuries or report a mechanism of injury that is not consistent with the actual injuries or when the story changes during interviews. Very minor variation in detail from witnesses may or may not be considered suspicious. Therefore, if fractures are present, not withstanding the aforementioned, multiple fractures, fractures of various stages of healing, complex skull fractures and fractures of the vertebral body are moderately suggestive of child abuse.
What are the signs and symptoms of skeletal injuries associated with child abuse?
The signs and symptoms of skeletal injuries related to child abuse include visible deformity of the limb or body part, swelling with tenderness and limited use of the affected limb. Some experts report that greater than 1/3 of abused children will have some type of bone fracture. If a child has multiple fractures involving multiple bones or multiple fractures in various stages of healing, child abuse should be strongly suspected in the absence of diseases of the bones.
What diagnostic tool does the American Academy of Pediatrics (AAP) recommend to consider when evaluating a child under the age of two years old for possible child abuse?
The AAP recommends that providers obtain a skeletal survey when evaluating children under the age of 2 years old for child abuse. Some research shows that 80% of occult fractures are found in children less than one year of age.
Is my child safer riding the school bus or traveling in another vehicle to and from school?
According to a report from the NHTSA (National Highway Traffic Safety Association), your child is safest in a bus when traveling to and from school. Children who are transported to and from school in other vehicles, travel on foot, or ride bikes, are more at-risk than those who ride the school bus, according to statistics from the report (click here to read the specific statistics). Overall, the report findings are consistent with historic data that named school buses 12 times safer than passenger vehicles for the transportation of students.
Car accidents can cause a range of injuries, from minor to even fatal. If your child has been injured or killed in an auto accident, whether while commuting to school or driving elsewhere, feel free to contact child injury attorney & car accident lawyer Chris Keane with your questions regarding liability, negligence, and other concerns. As an advocate for injured children and surviving families of fatal accident victims, Chris Keane will answer all your questions for free with compassion and regard for your unique situation.
Click here to contact Chris Keane via the web or call 1-888-592-KIDS.