Expanding the Role of Radiology in the Detection of Physical Elder Abuse

Abstract

Pediatric radiologists play a key role in the detection of child abuse, through the identification of characteristic fracture and injury patterns. Emergency radiologists have the potential to play an equally important role in the detection of elder physical abuse; however, existing literature shows that they currently play little to no part in this effort. We sought to examine the role of radiologists in the detection of physical elder abuse, and potential strategies to expand and optimize this role, by interviewing experienced health care providers who confront abuse at both ends of the age spectrum. Interviews were conducted with attending faculty from the fields of Emergency Radiology, Pediatric Radiology, Emergency Medicine, Geriatrics, and Pediatrics. Interviews explored subjects’ clinical experience with child/elder abuse; training received on abuse detection; common mechanisms of injury and imaging findings; and communications between radiologists and frontline, referring clinicians. Interviews were transcribed and coded using qualitative content analysis. Of 51 physicians contacted, 25 agreed to be interviewed, for a response rate of 49%. Interviewees included 7 emergency radiologists, 5 pediatric radiologists, 4 EM physicians, 5 geriatricians, and 4 pediatricians. 4 main themes, 3 sub-themes, and 2 minor themes emerged from data analysis. First, most radiologists reported never having read a case of suspected elder abuse, nor having received any specific training on the subject. This stood in stark contrast to the rigor with which child abuse is taught in radiology curricula. Physicians across disciplines agreed that the high prevalence of falls in the elder population, as well as common co-morbidities like osteoporosis and demineralization, posed significant obstacles to characterizing specific imaging correlates for elder abuse. One key child abuse detection strategy, the recognition of fractures inconsistent with reported mechanism, was noted to be applicable to elder abuse. For this reason, patient history and clinical context, including full information about injury mechanism and functional status, were deemed critical to radiographic interpretation of elder trauma. Importantly, communication of this information to radiologists was identified as a significant gap in current practice. Improvement in communication between clinical teams has the potential to lead to a more rigorous and effective abuse detection framework.