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Inclusion criteria

We included high quality case series / studies, where abuse had been confirmed. To minimise circularity in relation to confirmation of abuse, we included only those studies where the rank of abuse was 1 or 2. In order to address the role of non-radiological investigations in detecting abusive abdominal injury, we accepted studies with a lower rank of abuse (4-5) for this question, in order to determine if occult injuries were present.


See evidence sheets and critical appraisal forms for each year’s update





children aged 0 to < 18 years


studies with mixed child and adult subjects, where the children’s data could not be extracted


alive or deceased on presentation


inadequate clinical detail of included cases


injury confirmed by one or more of the following:


contrast studies


computed tomography (CT) scanning, with or without contrast




post mortem examination


studies including a mixture of abusive and accidental injuries, where the details of these two groups could not be extracted



studies exclusively addressing the outcome / management of visceral injuries



studies of sexual abuse, thus all ano-genital / rectal injuries


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