Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Concern for Physical Abuse

ED Team Assessment
No Findings Suggestive of Abuse
  • No injuries or risk factors indicating abuse present
  • No historical indicators of abuse
  • Physical exam findings explained by plausible developmentally appropriate mechanism or medical etiology
  • +/- Social Work consult
Findings with Low Concern for Abuse
  • Single injury with plausible accidental mechanism, but social concerns
  • or
  • Isolated linear skull fracture in infant
    > 4 mos with plausible mechanism
  • or
  • Historical/social concerns for possible abuse without identified injury
Findings Suggestive of Abuse
  • Witnessed or disclosed abuse
  • Injury pathognomonic of abuse
  • Injuries Suggestive of Abuse not explained by plausible mechanism
  • Occult injuries identified
No occult injuries on skeletal survey
No concerns for abuse on full assessment
Social Work Consult
Skeletal Survey Recommendations
Occult injuries on skeletal survey
  • No further work up for abuse
  • No CPS Report Indicated
  • Routine Follow-up
  • No occult injuries on skeletal survey
  • Some risk factors/concerns for abuse on full assessment
  • Consider
    • Child Protection Team Consult
    • CPS Report
    • Admission for treatment, safety Planning
KOPH Considerations
  • Admit KOPH
    • Safety planning, determining disposition needed
    • Age > 2 yrs with isolated orthopedic injury
  • Transfer to PHL
    • Trauma Consult required
Posted: November 2010
Revised: February 2024
Editors: Clinical Pathways Team