This will be sufficient to define any surgically correctable condition. Most patients should undergo MRI eventually to define the extent of the injury fully, determine the prognosis, and provide evidence for intervention and criminal proceedings. Abdominal injuries are uncommon in abused infants, and imaging studies should be tailored to the specific clinical concern. CT and ultrasound are helpful in establishing whether internal abdominal trauma has occurred in infants thought to have been shaken. The use of MRI has helped detect old and new intracranial injuries and has aided recognition of subtle instances of repetitive shaking.
Repetitive abuse has important legal and clinical implications.
If abuse is repetitive, the child is at high risk for further injury unless legal action is taken. Establishing that there has been a pattern of abuse can also help in identifying potential perpetrators and may lead to increased legal penalties. From the perspective of the protection of the child or the criminal prosecution of the abuser, it is not as important to distinguish the precise mechanism of injury as it is to be certain that the event was nonaccidental. Pediatricians should not be deterred from testifying when the cause of the nonaccidental injury is not entirely clear. Shaking a child creates an imminent risk for an acute injury.