Aims: To determine whether abused and non-abused children differ in the extent and pattern of bruising, and whether any differences which exist are sufficiently great to develop a score to assist in the diagnosis of abuse. Methods: Total length of bruising in 12 areas of the body was determined in 133 physically abused and 189 control children aged 1-14 years. Results: Our method of recording bruises by site, maximum dimension, and shape was easy to use. There were clear differences between cases and controls in the total length of bruises. These differences were at their greatest in the head and neck and were less notable in the limbs. A scoring system was developed using logistic regression analysis using total lengths of bruising in five regions of the body. Good discrimination between the two sets of children was achieved using this score; by including a variable that indicates whether a bruise had a recognisable shape the discrimination could be made even better. Given a prior probability of abuse the score can be used to give posterior odds of abuse, given a particular bruising pattern. Conclusions:The scoring system provides a measure that discriminates between abused and non-abused children, which should be straightforward to implement, though the results must be interpreted carefully. We do not see this score as replacing the complex qualitative analysis of the diagnosis of abuse. This clearly includes history as well as examination, but rather as the beginning of the development of an important aid in this process. P aediatricians are often asked for an opinion on whether a particular pattern of bruising is caused by abuse. This might arise in a variety of settings-clinical, child protection, or in legal proceedings. Although some studies have looked at the age of children and bruising, 1 2 and others have looked at the age of individual bruises, 3-5 the evidence base 6 7for coming to a conclusion on an individual pattern of bruising is very limited. One reason for this is that child protection is a multidisciplinary activity, led by social workers whose research base is largely qualitative. Another is the difficulty of obtaining data on bruises on non-abused children. There is also the problem of recording information on bruises in a way that is not invasive and yet is in sufficient detail for the results to be analysed statistically. There are two related but separate issues to be investigated. Is the extent and pattern of bruising different in abused and non-abused children? Are any differences sufficiently great to develop a score to assist in the diagnosis of abuse? In a preliminary study 7 we collected data on bruises in three areas of the body of abused and non-abused children, and used Bayes' theorem 8 to arrive at a posterior probability that a particular bruising pattern was the result of abuse. That work was limited by certain assumptions about the independence of bruising patterns in different regions of the body. Therefore, we carried out a study in which bruises were recorded in more deta...

BackgroundNational guidance recommends CT-head for all children <1 year old with suspected physical abuse, and to be considered for those <2 years old to exclude abusive head trauma.ObjectivesTo investigate whether this guidance is followed, and the associations between clinical presentation and CT findings, to determine whether guidance could be refined.Materials and methodsA retrospective case note review of all children <2 years old who underwent medical assessment for suspected abuse (2009–2017). Outcome measures were frequency of CT-head, and diagnostic yield of intracranial injury, skull fracture or both.ResultsCT-head was undertaken in 60.3% (152/252) of children <12 months old and 7.8% (13/167) of those aged 12–24 months. The diagnostic yield in children who had a CT-head was 27.1% in children <6 months old, 14.3% in those 6–12 months old (p=0.07) and 42.6% (6/13) in those 12–24 months old. For those with head swelling or neurological impairment, it was 84.2% (32/38). In children <12 months old without these clinical features, the estimated prevalence of occult head injury was 6.1% (7/115). The strongest predictors of an abnormal CT-head were swelling to the head (OR 46.7), neurological impairment (OR 20.6) and a low haemoglobin (OR 11.8).ConclusionAll children <2 years of age with suspected physical abuse and neurological impairment or head swelling should undergo CT-head. Where the technical skills and the requisite expertise to interpret MRI exist, an MRI scan may be the optimal first-line neuroimaging investigation in infants who are neurologically stable with injuries unrelated to the head to minimise cranial radiation exposure.

IntroductionChildren who are suspected to have sustained a non-accidental injury (NAI) are investigated with radiological images and there may be variation in practiceObjective/aimWe aimed to identify the standard investigations performed in young children (<2 years old) suspected to have sustained an NAI across all Welsh Health Boards.MethodsA questionnaire was sent out to all 8 Named Doctors for Safeguarding. It focussed on the choice of radiological investigations, the availability of bone scans, the standards for radiological reporting and the safeguarding procedure.ResultsFull responses were achieved.; 7/8 centres routinely request a head CT scan in under 1 year olds and 4/8 in under 2 year olds. All centres arrange an initial skeletal survey but only 4 centres arrange a delayed 2nd skeletal survey, 2 centres obtain contemporaneous bone scans but 2 centres do not arrange any follow up imaging. 62.5% of centres stated that their imaging is in accordance with national guidance. All centres practice double reporting. There was appropriate involvement of Children’s services throughout.DiscussionThere good practice but clear variation across regions which may have significant implications for the child and is not in line with the Welsh Assemblies NHS Prudent health care theme. Less than 2/3 of health boards followed national standards for imaging. This variation will impact safeguarding arrangements and level of disruption to the child and its family. Lack of resources may be the cause of the variation in some cases.

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