Occult Abdominal Trauma Screening in the Evaluation of Suspected Child Physical Abuse.

Abstract

Background and objectives: Occult abdominal trauma (OAT) screening with transaminases, followed by abdominal computed tomography (CT) for transaminase values greater than 80 IU/L, has been recommended in cases of suspected physical abuse. This study aimed to evaluate case characteristics associated with OAT evaluation and determine OAT prevalence in these children.

Methods: Injured children aged younger than 60 months undergoing Child Abuse Pediatrics (CAP) consultation for suspected physical abuse from February 2021 to May 2023 were identified in CAPNET, a multicenter research network. Children with symptoms or signs of intra-abdominal injury were excluded. We identified case characteristics associated with transaminase screening and abdominal CT imaging using logistic regression and determined OAT prevalence.

Results: Of 6161 eligible children, 3982 (64.6%) underwent transaminase screening; 687/3982 (17.3%) had transaminases greater than 80 IU/L with 298/687 (43.4%) undergoing abdominal CT imaging. Variability in screening and imaging practices was identified between CAPNET sites. In a fully adjusted model, transaminase screening was associated with ages younger than 6 months, greater clinical severity, and site. CT imaging was associated with site, inpatient status, and higher transaminase range. We identified 16 OAT cases in children with transaminases greater than 80 IU/L, representing 2.3% of CAP-evaluated children with positive transaminase screening and 0.3% of all eligible children.

Conclusions: Providers often perform transaminase screening but not abdominal CT imaging despite transaminases greater than 80 IU/L. The low prevalence of OAT suggests that routine transaminase screening in suspected child physical abuse evaluations may not be necessary when all signs and symptoms of abdominal injury are absent.