EVALUATION OF RADIOLOGICAL FINDINGS IN TERMS OF PHYSICAL ABUSE IN CHILDREN UNDER 4 YEARS OF AGE ADMITTED TO EMERGENCY DEPARTMENT

Abstract

Physical abuse is defined as non-accidental injury. For 0-3 years of age children, evaluated in the emergency department, the possibility of physical abuse should be considered. The purpose of this study is to discuss the role of radiological findings in the assessment of physical abuse suspicion. Children in 0-3 years of age, admitted with fall to the emergency department of a university hospital in 2018, were retrospectively evaluated on hospital automation system. Data was obtained from electronic health records. The cases were examined in terms of age, gender, falling features, physical and radiological findings related to trauma and suspicion of abuse. Data was analyzed in SPSS program. In 100 cases, 52 (52.0%) were male and the mean age was 28.7±10.6 months. The clinical diagnoses of the cases were 51 (51.0%) falling from the same level, 11 (11.0%) falling from one level to another, and 38 (38.0%) ‘only’ falling. Posttraumatic radiological findings were as follows: 19 (19.0%) cases had soft tissue injury with bone fracture and/or joint dislocation; 17 (17.0%) cases had isolated soft tissue injury and 1 (1.0%) had temporal bone fracture and intracranial traumatic changes. In 11 (11.0%) cases had long bone fractures, 9 (9.0%) were diaphyseal fractures. Two (2.0%) cases had hand-finger, 1 (1.0%) clavicle, 1 (1.0%) calvarial and 1 (1.0%) facial bone fractures. The case with clavicle fracture could not be evaluated in terms of physical abuse suspicion, because of unknown condition of walking. The suspicion of physical abuse was considered in 1 (1.0%) case due to delay in hospital admission. Long bone diaphyseal fractures were most common in children aged 0-3 years. Since this finding showed low specificity to physical abuse, no suspicion of physical abuse was radiologically considered. The delay in hospital admission reveals the importance of evaluating cases from a multidisciplinary point of view in terms of suspicion of physical abuse.