Child Protection Evidence - Visceral injuries

Child Protection Evidence is a resource available for clinicians across the UK and internationally to inform clinical practice, child protection procedures and professional and expert opinion on the legal system. This systematic review evaluates the literature on abusive and non-abusive visceral injuries.

About the review

This systematic review evaluates the scientific literature on visceral injuries published up until May 2014.

It aims to answer the following clinical questions:

  • What are the features of visceral injuries occurring as a consequence of physical abuse?
  • What is the value of non-radiological investigations in detecting abusive abdominal injury?

Whilst almost every organ of the body has been reported as having been injured, the literature predominantly addresses abdominal injuries. In addition, the review sought to evaluate the use of serological tests in visceral injuries.

The implications for practice and research, and other useful references are included in the review.

Key findings

  • Many abdominal injuries, in particular hepatic injury, may be clinically occult and thus active consideration of blunt abdominal injury in children with suspected abuse is necessary.
  • Abdominal injuries such as transection or laceration of the third / fourth part of the duodenum in children aged less than five years, particularly those less than two years old, who have not experienced a motor vehicle collision should prompt specific child protection investigations.
  • When a child sustains head injury or becomes unconscious as a consequence of abusive physical abuse, abdominal injuries must be considered during their investigation.
  • Many children sustaining abusive abdominal injury have evidence that there has been repeated blunt abdominal injury, although they have not come to attention with previous injuries. Thus, non-specific symptoms in young children with suspected abuse should prompt abdominal investigations.
  • While a positive serology test may warrant further investigation, those with negative serology may also have significant intra-abdominal injury.
  • Infants less than six months of age with an isolated bruise may still have occult abdominal injury.

Disclaimer: This is a summary of the systematic review findings from our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

Original reviews and content © Cardiff University, funded by NSPCC
Published by RCPCH July 2017

While the format of each review has been revised to fit the style of the College and amalgamated into a comprehensive document, the content remains unchanged until reviewed and new evidence is identified and added to the evidence-base. Updated content will be indicated on individual review pages.