When physical abuse of a pediatric patient is suspected, how should radiologists and the rest of the imaging team proceed? Which modalities make the most sense? A new guideline from the Royal College of Radiologists (RCR) and Society and College of Radiographers (SCoR) in the United Kingdom addressed those very issues and many more.

In September 2017, the RCR and SCoR published a document, “The radiological investigation of suspected physical abuse in children,” detailing the imaging procedures recommended when physical abuse of a child is suspected. It was an update to a similar guideline from 2008.

P. J. Strouse, MD, with the department of radiology at the University of Michigan Health System in Ann Arbor, wrote about the guideline for Clinical Radiology, calling it “timely in providing an exceptionally strong framework upon which to provide imaging service for suspected victims of child abuse with high-quality, increased certainty, consistency and compassion.”

Treating patients who may have been physically abused can be “cryptic and confusing,” Strouse added. But anytime that suspicion exists, “imaging should be pursued.”

Strouse also noted that pediatric radiologists, pediatric neuroradiologists, radiographers/radiologic technologists, child abuse pediatricians and other specialists all worked together to complete the guideline, which is more than 50 pages long and includes 45 recommendations for providing the best possible care to these patients.

“I congratulate the working group on its collaborative effort, and in particular, involving radiographers,” he wrote. “Within the radiology department, it is the radiographers who spend the most time with the child and the parents and it is the radiographers who obtain the images.”

The guideline helps providers make decisions about selecting the most effective imaging modality. While skeletal surveys are sometimes all that is necessary, supplemental imaging may be needed as well. Head CT, for instance, is the recommended exam for “infant patients with or without acute neurological compromise.” Body CT or MR imaging are also sometimes necessary.

The RCR/SCoR guideline emphasizes that time is especially important in these cases. Skeletal studies should be performed within 72 hours, and a consensus report should be completed by two radiologists within 24 hours. When a provider can’t deliver the required care in time, it is recommended they turn the patient over to a facility that can.

“Providing interpretation as soon as possible after completion of the study is desirable and should be strived for,” Strouse wrote. “Conversely, interpretation of a skeletal survey requires careful review of many images, collaboration, and consensus with a second reader, and construction of a well-written, complete report useful to both medical personnel and the legal community. This takes time. Regardless, the balance between expediency and accuracy of reports must focus on the wellbeing of the child.”

While both the RCR and SCoR are from the U.K., Strouse concluded his analysis by pointing out that specialists from all over the world may benefit from referencing their updated recommendations on this important topic. “The authors are complemented on a marvelous document, which will improve the healthcare and wellbeing of children in the U.K. and beyond,” he wrote.

The guideline can be read on the RCR’s website.