Child abuse: Impact of the clinical presentation and imaging findings on the physician's notification to the authorities - a retrospective cross-sectional study

BACKGROUND: Early notification of suspected child abuse (SCA) to the authorities is a public health issue. OBJECTIVE: To assess clinical and imaging findings associated with notification. METHODS AND SETTINGS: Retrospective, single-center cross-sectional study involving children under three years of age with SCA. Clinical and imaging findings were collected. Reports of suspected child abuse were analyzed according to patients' demographic characteristics, clinical features, and imaging findings. RESULTS: We included 126 children suspected of child abuse. Notification was more likely for neurologic ([odds ratio] OR = 5.49, [95% confidence interval] 95% CI [1.29, 23.36], p= 0.021) or orthopedic signs (OR = 6.00, 95% CI [1.02, 35.38], p= 0.048). Positive findings in MRI (OR = 7.35, 95% CI [3.23, 16.70], p < 0.001), skeletal survey (OR = 2.46, 95% CI [0.97, 6.25], p= 0.059), bone scintigraphy (OR = 11.0, 95% CI [1.34, 90.21], p= 0.026) and fundus examination (OR = 9.14, 95% CI [2.51, 33.29], p < 0.001) were also associated with a notification. The absence of a skeletal survey (OR = 0.09, 95% CI [0.02-0.33], p < 0.001), bone scintigraphy (OR = 0.21, 95% CI [0.09-0.49], p < 0.001), or fundus examination (OR = 0.08, 95% CI [0.02-0.29]) was significantly associated with a lower likelihood of suspected child abuse notification. CONCLUSION: Good knowledge of the clinical and imaging signs (including sentinel lesions and standardized additional examinations) that are suggestive of child abuse is essential for child abuse detection and notification to the authorities.