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

No Findings Suggestive of Abuse
  • No injuries indicating abuse present
  • No historical indicators of abuse
  • Physical exam findings explained by plausible developmentally appropriate mechanism or medical etiology
  • +/- Social Work consult
Note:
Household contacts or siblings of children with abusive injuries are at high risk
No occult injuries on skeletal survey
No concerns for abuse on full assessment
Findings with Low Concern for Abuse
  • Single injury with possible accidental mechanism
  • Historical/social concerns for possible abuse without identified injury
Social Work Consult
Skeletal Survey Recommendations
Findings Suggestive of Abuse
  • Witnessed or disclosed abuse
  • Injury pathognomonic of abuse
  • Injuries Suggestive of Abuse not explained by plausible mechanism
  • Occult injuries identified
Occult injuries on skeletal survey
Recommendations
  • No further work up for abuse
  • No CPS Report Indicated
  • Routine Follow-up
Recommendations
  • 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
  • Historical/social concerns for possible abuse without identified injury
Recommendations
Posted: September 2018
Revised: November 2018, April 2020
Authors: P. Scribano, MD; J. Wood, MD; K. Henry, MD; V. Scheid, MD; L. Palacio, LSW; C. Jacobstein, MD; J. Lavelle, MD