Variation in Use of Neuroimaging in the Care of Infants Undergoing Subspecialty Evaluations for Abuse: A Multicenter Study.
Document Type
Article
Publication Date
3-2025
Identifier
DOI: 10.1016/j.acap.2024.10.009
Abstract
OBJECTIVES: 1) To quantify hospital-level variation in use of neuroimaging to screen for intracranial injury (ICI) among infants without overt signs or symptoms of head trauma undergoing subspecialty evaluations for physical abuse; 2) to assess for disproportionality in neuroimaging based on race and ethnicity and insurance type.
METHODS: This was a cross-sectional study of infants ageCAPNET, a multicenter child abuse research network. Infants were included if they underwent a skeletal survey and lacked overt signs of possible ICI or blunt head injury. Outcome was completion of neuroimaging (computed tomography [CT] or magnetic resonance imaging [MRI]). Multivariable logistic regression was used to assess associations between demographic, clinical, and hospital factors with neuroimaging use.
RESULTS: Of 1114 infants, 746 (67%) underwent neuroimaging ranging from 51% to 80% across CAPNET hospitals. In multivariable analysis, young age, presence of rib fracture(s), and site had significant associations with neuroimaging. Insurance type and race and ethnicity did not contribute significantly to the model. After adjustment for case-mix, there was significant variation across hospitals, with neuroimaging use ranging from 51% (95% CI: 43%, 59%) to 79% (95% CI 71%, 88%).
CONCLUSION: We identified significant variation in neuroimaging use across CAPNET hospitals, highlighting the need for guideline development and care standardization during the care of infants undergoing abuse evaluations.
Journal Title
Acad Pediatr
Volume
25
Issue
2
First Page
102597
Last Page
102597
MeSH Keywords
Humans; Infant; Male; Female; Child Abuse; Cross-Sectional Studies; Magnetic Resonance Imaging; Neuroimaging; Tomography, X-Ray Computed; United States; Craniocerebral Trauma; Infant, Newborn; Logistic Models; Insurance, Health
PubMed ID
39490894
Keywords
CAPNET; child abuse; neuroimaging; occult head trauma
Recommended Citation
Alpert E, Wood JN, Shults J, et al. Variation in Use of Neuroimaging in the Care of Infants Undergoing Subspecialty Evaluations for Abuse: A Multicenter Study. Acad Pediatr. 2025;25(2):102597. doi:10.1016/j.acap.2024.10.009
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