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

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
  • Note:
    • Household contacts or siblings of children with abusive injuries are at high risk
    • Age < 6 months with any injury warrants consideration of abuse
No occult injuries on skeletal survey
No concerns for abuse on full assessment
Findings with Low Concern for Abuse
  • Single injury with plausible accidental mechanism, but social concerns
  • 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
Recommendations
Posted: September 2018
Revised: November 2018, April 2020, February 2021
Authors: P. Scribano, MD; J. Wood, MD; K. Henry, MD; V. Scheid, MD; L. Palacio, LSW; C. Jacobstein, MD; J. Lavelle, MD