Possible Role of Thoracic Ultrasound in the Diagnostic Pathway of Infant Abuse in the Pediatric Emergency Department

Abstract

espite the fact that child maltreatment is a global problem with serious life-long physical and psychological or psychiatric outcomes, it is often difficult to detect. In the area of physical abuse, fractures are common in 12% to 20% of the cases, particularly in the youngest children in the first year of life. 1,2 Diagnostic imaging is an essential part of the investigation of suspected physical abuse. The radiographic skeletal survey is the primary imaging examination for detecting fractures with frontal, lateral, and also oblique views, especially to increase the accuracy of diagnosing rib fractures, which are strong positive predictors of abuse. 3,4 Furthermore, a follow-up skeletal survey, approximately 2 weeks later, increases the diagnostic yield. 5 Unfortunately, although all imaging studies are performed with exposure that is as low as reasonably achievable, the child can be exposed to a high dose of ionizing radiation. This aspect should not be underestimated; in fact, children are considered to have an increased risk of morbidity and mortality from radiation compared with their adult counterparts, because of both organ sensitivity and longer life expectancy. [6][7][8] Therefore, to reduce the dose of ionizing radiation and speed up diagnostic times, thoracic ultrasound could represent an effective diagnostic tool for early diagnosis of thoracic bone fractures in suspected physical child abuse in the emergency department.

Point-of-Care Thoracic Ultrasound in Children: New Advances in Pediatric Emergency Setting

“…In fact, the use of thoracic ultrasound could be effective in the early identification of rib fractures, thus confirming the suspicion of child abuse. The use of this radiological technique is also useful in decreasing the radiation dose to which children may be subjected with radiography [103].…”

Lung ultrasound in children drowning victims in pediatric emergency department

“…Lung ultrasound is rapidly becoming a valuable tool in the hands of the pediatrician 2 and has multiple fields of application: in traumatic pathology, cardiac diseases and lung diseases 3–5 …”

Lung Ultrasound: Its Findings and New Applications in Neonatology and Pediatric Diseases

“…Rib fractures are suspected in pediatric age; in fact, they represent indicators of child abuse. Therefore, thoracic ultrasound could be helpful in identifying, promptly, children at risk of abuse, reducing the exposure to ionizing radiation [ 81 , 82 ].…”