In a 2-month-old with visible rib fractures on radiograph, the next most critical evaluation to obtain is which study?

In a 2-month-old with visible rib fractures on radiograph, the next most critical evaluation to obtain is which study?

• A. Head CT Scan
• B. Long Bone Series
• C. Coagulation Profile
• D. Retinal Ophthalmologic Exam

Answer: (A)

When an infant has rib fractures, abuse must be suspected and the most urgent concern is a potential abusive head trauma with hidden brain injury. The immediate priority is to image the brain with a head CT scan without contrast to quickly identify intracranial injuries such as subdural or epidural hematomas, contusions, or edema. Detecting these injuries promptly guides life-saving decisions and management. Other studies have their roles in the overall workup—long bone surveys help document additional fractures, coagulation testing can assess bleeding risk, and an ophthalmologic exam can reveal retinal hemorrhages associated with abuse—but none are as critical as rapidly assessing the brain for injury in this scenario.

When an infant has rib fractures, abuse must be suspected and the most urgent concern is a potential abusive head trauma with hidden brain injury. The immediate priority is to image the brain with a head CT scan without contrast to quickly identify intracranial injuries such as subdural or epidural hematomas, contusions, or edema. Detecting these injuries promptly guides life-saving decisions and management.

Other studies have their roles in the overall workup—long bone surveys help document additional fractures, coagulation testing can assess bleeding risk, and an ophthalmologic exam can reveal retinal hemorrhages associated with abuse—but none are as critical as rapidly assessing the brain for injury in this scenario.