Differential diagnosis of child abuse injuries

Approach to the differential diagnosis of child abuse injuries:

  • Rib fracture – especially posteromedial has high specificity for abuse
  • Classic metaphyseal lesion – has high specificity for abuse
  • Femur fracture – in < 3 years old without a good history is suspicious for abuse
  • Skull fracture – if complex has moderate specificity for abuse
  • Subdural hematoma – determining its age can be challenging
  • Diffuse cerebral edema – is not specific for abuse
  • Duodenal hematoma – suspect this in abused child who is vomiting with feeding
  • Hypoperfusion complex – is marker of hypovolemic shock
    Note: skeletal survey should be repeated after 2 weeks in < 2 years old as rib fractures + classic metaphyseal lesions can be initially subtle and only seen on later imaging