Skeletal survey identifies sibling abuse

Siblings of abused children, especially twins, are at high risk for physical abuse that may not be detected on physical examination, according to a new report. The findings support routine skeletal surveys for contacts of injured, abused children who are younger than 24 months, regardless of physical examination findings.

In this observational, multicenter, cross-sectional study, 20 US child abuse teams used a common screening protocol to examine contacts of abused children with serious physical injuries. A total of 627 index children and 479 siblings and other children sharing the same household or other care environment were included in the study.

In addition to physical examination, the screening protocol recommended skeletal survey for contacts who were younger than 24 months and neuroimaging for contacts younger than 6 months. Approximately one-quarter of contacts did not undergo the screening indicated by the protocol.

Skeletal survey identified at least 1 abusive fracture in 16 (12%) of the 134 contacts younger than 24 months. Twins were at increased risk of fracture compared with nontwin contacts. None of the fractures had associated signs or symptoms such as bruising or swelling, and none was suspected clinically.

The researchers recommend physical examination of contacts of abused children because such examinations are inexpensive and safe and may identify specific indications of abuse.

They point out, however, that absence of evidence of injury on physical examination does not rule out the potential for other abusive injuries, and they recommend skeletal surveys for all contacts of physically abused, injured children younger than 24 months, whether or not physical examination findings are positive.

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