Statement of Problem

Every year, more than 120,000 children are confirmed victims of physical abuse in the United States, but the true incidence is likely higher. A major challenge in diagnosing abuse in young children is the fact that many abuse injuries are only discovered via screening imaging, such as X-rays. These type of “hidden injuries,” which could be cracked ribs or brain injury that are only revealed by screening imaging, are called “occult injuries.” Research has shown that the decision to screen is heavily influenced by the socioeconomic and racial background of families and that different hospital systems vary greatly in how often they screen for these occult injuries. This can lead to certain children being over-screened and others under-screened on the basis of social, cultural and socioeconomic factors. A lack of clear criteria on the appropriate use of occult injury screening has hindered efforts to address these disparities and improve the quality of care.