About half of young children brought to hospitals with injuries indicating that they have been abused were not thoroughly evaluated for other injuries, and the use of proper care is less likely to happen in general hospitals than in those that specialize in pediatrics, a study released Monday found.

The researchers examined whether hospitals are adhering to guidelines from The American Academy of Pediatrics (AAP) that all children younger than 2 years old suspected of being victims of child abuse undergo skeletal surveys, a series of X-rays used to identify broken bones that are not readily apparent, called occult fractures.

The results, published in the journal Pediatrics, reveal a significant variation in hospitals’ evaluation of occult injuries, despite the AAP’s recommendations.

“In the young population, medical providers can miss important injuries. … Skeletal surveys can help identify them,” said Dr. Joanne Wood, an assistant professor of pediatrics at the University of Pennsylvania Perelman School of Medicine and senior author of the study.

Wood and her colleagues highlight the importance of skeletal surveys, explaining how the detection of occult fractures can point to the need for additional medical services, provide additional evidence of abuse and help protect the child.

The study looked at records for nearly 4,500 children treated at 366 hospitals around the country between 2009 and 2013.  That group included children under the age of 2 who had been diagnosed with physical abuse and children under the age of 1 with high risk injuries.

Past research has demonstrated that skeletal surveys are key to assessing young children suspected as victims of abuse. Prior to this study, however, there was little information on how hospitals in general have adhered to the AAP’s protocol.

Researchers in the current study found that across all the hospitals, 48 percent of the children younger than 2 with an abuse diagnosis underwent proper occult fracture examinations. But a prior study by Wood and her colleagues reveal that approximately 83 percent of children suspected of being victims of child abuse underwent skeletal surveys when treated in pediatric hospitals.

This study reveals “a need for standardization of care” across hospitals, said Wood.

Dr. Robert Sege,  the director of family and child advocacy at Boston Medical Center and member of the AAP Committee on Child Abuse and Neglect, said in an interview the disparity in hospital practices is due to “a big educational gap for colleagues who primarily see adults.”

“Doctors who treat children should be trained to know about [occult evaluation] procedures when there is abuse suspicion,” he said.

In a commentary accompanying the study, Dr. Kristine Campbell, assistant professor of pediatrics at the University of Utah, suggested that follow-up research is necessary, as “no study reveals how often occult fractures provide the critical evidence to assure a child’s protection.”