Outcome Data Needed: Interpreting Variation in the Medical Evaluation of Child Physical Abuse.

Since 1991, the American Academy of Pediatrics has maintained that the skeletal survey is mandatory in the evaluation of physical abuse for children younger than 2 years of age. Since 1995, the American College of Radiology has strongly recommended the skeletal survey in the evaluation of abuse. Clinical research affirms the utility of skeletal surveys in identification of occult fractures in 10% to 30% of young children evaluated for physical abuse, a yield higher than many evaluations undertaken in the assessment of febrile infants or closed head injury in children. UpToDate summarizes decades of clinical research and practice guidelines with the statement, “Concern for physical abuse in children younger than 24 months of age is an absolute indication for obtaining a skeletal survey.” In this edition of Pediatrics, however, researchers from the Children’s Hospital of Philadelphia report that US physicians fail to obtain skeletal surveys, or any other radiologic evaluation for occult fracture, in almost half of children younger than 2 years of age diagnosed with physical abuse.