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
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
- Trauma Consult/Admission as Clinically Indicated
- Screen for Occult Injury
- Laboratory Testing for Injury, Medical Conditions
- Skeletal Survey, Head Imaging, Other Imaging
- Social Work Consult
- Documentation Tips
- File CPS report
- Consider
- Police report
- Admission Considerations
- Trauma Admission
- Any patients with acute injury, admit to trauma or appropriate surgical service
Admitting Service Selection for Trauma Patients Job Aid
- Any patients with acute injury, admit to trauma or appropriate surgical service
- General Pediatrics Admission
- Patients requiring medical evaluation of safety planning
- Trauma Admission
- Consider:
Posted: September 2018
Revised: February 2021
Authors: P. Scribano, MD; J. Wood, MD; K. Henry, MD; V. Scheid, MD; L. Palacio, LSW; C. Jacobstein, MD; J. Lavelle, MD
Revised: February 2021
Authors: P. Scribano, MD; J. Wood, MD; K. Henry, MD; V. Scheid, MD; L. Palacio, LSW; C. Jacobstein, MD; J. Lavelle, MD