Radiology
Radiological examinations are an important tool in the evaluation of the child/adolescent suspected of having injuries from abuse. These examinations are used to identify acute injury and to evaluate for previous injury. These examinations should be performed at a facility with an appropriately skilled radiology team. A pediatric radiologist, if available, will have a significant role in the diagnosis of child abuse by identifying injuries that were previously unsuspected (occult) or unexplained. For example, rib fractures in infants, a suspicious finding for child abuse, may be found incidentally on a chest X-ray obtained for another reason, such as wheezing or respiratory distress. After bruises, fractures are the second most common injury from physical abuse (Palusci et al 2024).
A radiological examination does not substitute for and cannot be used effectively without an appropriate history and physical examination. Radiological examinations should only be performed when the child/adolescent's clinical condition allows for them to be done safely. Knowing the protocol for obtaining X-rays at your healthcare facility will maximize the quality of information obtained.
It is good practice to obtain caregiver (parent or legal guardian) consent for radiographic examinations. However, consent is generally not required when abuse is suspected. X-rays specifically for the sole purpose of evidence collection, as in most cases for skeletal surveys, should be discussed with the non-offending caregiver or legal guardian. Verbal assent from older children should be obtained. Refusals should be addressed based on a risk versus benefit analysis. Relevant laws should be reviewed by providers in their own geographic locations. If consent is not obtained, clearly document the reasons in the medical record.
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