Summary

The annual incidence of physical child abuse is 4% to 20%. Notification of suspected child abuse to the authorities is a public health issue. The main objective was to identify the clinical signs and paraclinical factors that prompted physicians to notify the authorities of suspected child abuse. This is a retrospective cohort study at the Amiens University Hospital. We included suspected victims of child abuse under the age of 3 admitted to a pediatric unit between 01/12/2013 and 01/04/2019. Clinical data and imaging findings were retrospectively collected from the medical records and then univariate analyses were performed. We included 126 children with a mean age of 7.7 months (0.4–33 months). Notification was more likely when the child presented with neurological signs (OR [95%CI] 5.5 [1.3–23.4]) and orthopedic symptoms (OR [95%CI]: 6.0 [1.0–35.4]). With regard to imaging data, suggestive findings in cMRI (OR [95%CI]: 7.3 [3.2–16.7]), bone scintigraphy (OR [95%CI]: 11.0 [1.3–90.2]) and fundus examination (OR [95%CI]: 9.1 [2.5–33.3]) were significantly associated with the notification of suspected child abuse. Compared to the highly trained units, basic trained units had an increased risk to break the guidelines with no cMRI (OR: 10.0 95%CI [3.8–26.3]), no skeletal survey (OR: 19.0 95%CI [6.0–60.6]), no bone scintigraphy (OR: 24.6 95%CI [8.5–70.8]), no fundus (OR: 13.6 95%CI [5.1–35.8]) and no social assessment (OR: 9.9 95%CI [4.1–24.1]). Child abuse is a difficult diagnosis and its management requires advanced medical knowledge and skills. The use of complementary examinations is essential to the diagnosis and requires specialized team works. It would seem interesting to set up a medico-social protocol containing the national guidelines. However, we must not forget that some non-specific clinical signs can in certain cases be linked to abuse.