Yield of injury testing for contacts of children evaluated for physical abuse

Background: Siblings and household contacts of physically abused children are at increased risk for physical abuse and may have injuries that are not clinically apparent. However, injury testing recommendations for contact children remain debated. Objective: Our objective was to describe testing practices and yield for contacts of physically abused children. Participants and settings: This is a cross-sectional study of children <10 years old evaluated for physical abuse at 10 US pediatric referral centers in the CAPNET research network. Methods: We report the proportion of contact children who had a skeletal survey (SS) or neuroimaging and describe the proportion of tests that identified injuries. Results: Among 6256 index evaluations, 4863 contacts were identified. Among 794 contacts with physical examinations, 530 had no findings on physical examination and 694 had no history of trauma. Among 316 contacts <24 months old where the index child had high concern for abuse, 196 (62%) had a SS and 20 had fractures identified by the SS. SS completion was more common for twins, contacts <12 months old, and contacts with findings on physical exam. Among 123 contacts <12 months old where there was high concern for abuse in the index child, 49 (40%) had neuroimaging. Of these, 5 had intracranial hemorrhage; all were twins. Conclusions: When skeletal survey and neuroimaging were completed in contacts of abused children, injuries were more common in twins and younger contacts.