Non-accidental injury (NAI)

61 Non-accidental injury (NAI)


NAI, or child abuse, is a topic so large and important that it merits a book in itself. Numerous complex imaging investigations may be involved. The aim of this short chapter, therefore, is not to enable the junior doctor to confidently diagnose and manage a child with suspected inflicted injury, but rather to increase the junior doctor’s awareness of what unfortunately is a relatively common problem, and to help them recognize some of the appearances on plain film radiology.


If this diagnosis is suspected the radiology should be reviewed by a consultant in paediatric radiology. The condition should be managed at consultant level, with involvement of several specialties including paediatrics and radiology.



Background


Non-accidental injury should be considered with certain specific patterns of injury. A high index of suspicion is required to make the diagnosis. It is important to do so though, because if it is missed, the child may be subjected to a fatal injury the next time.


Injuries to very young children are particularly suspicious: for example, it is difficult for a non-weight-bearing child to sustain a fracture of a weight-bearing limb.


Whilst radiology is important in this condition, the diagnosis should be made on clinical and radiological grounds.



Clinical features


A thorough assessment needs to be made.


The history may be inconsistent with the injury. Does the proposed mechanism fit with what you see? Injuries include head injury (subdural haematoma), fractures (see below) and abdominal injuries.


Disabled children are at higher risk.



Differential diagnosis


Accidental injury needs to be differentiated from non-accidental injury.


Skeletal dysplasias such as osteogenesis imperfecta can also cause fractures and mimic NAI.



Radiological features


The commonest injuries seen in NAI are skeletal.


Long bone fractures are the commonest injury in NAI, but carry a low specificity. These may present to an emergency medicine junior doctor or to paediatrics, so if these patterns are suspected, senior help should be sought.


A skeletal survey will normally be performed if NAI is suspected – this consists of individual radiographs of different areas of the body.


The following injuries are suggestive of NAI:


• metaphyseal fractures – ‘classic metaphyseal lesion’ (CML)

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Aug 20, 2016 | Posted by in ULTRASONOGRAPHY | Comments Off on Non-accidental injury (NAI)

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