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 the 31st May 2018.

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?

There has been limited evidence identified since the 2014 update and so the key findings remain unchanged. A small number of case reports published between 2014 and 2018 have been included.

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 key evidence statements, research implications, limitations 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
  • In the child sustaining head injury or who is unconscious as a consequence of their abusive injuries, 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 6 months of age with bruising but no other symptoms or signs of injury may still have occult abdominal injury 
  • Absence of bruising does not preclude the presence of significant abdominal injury as up to 80% of cases may have no bruising present

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 November 2018

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.