Abuse, Physical Clinical Pathway — Outpatient Specialty Care and Primary Care

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Provider Resources

Related Pathways

Children with Physical Abuse Concerns

Primary Care Referral Recommendations and Communications to ED

Clinician Assessment
History & Physical Exam (PE)
- Review Historical
- Physical Exam indicators of abuse

Historical Indicators of Abuse

Physical Exam Indicators of Abuse

Injuries Suggestive of Abuse

Low concern for abuse

History, PE not Supportive/Suggestive of Abuse
+/- Historical indicators
Physical exam indicators of abuse explained by history
No injuries indicative of abuse present

Concern for abuse

History, PE or Injuries Concerning for Abuse
Photodocumentation
Identify Other Children at Risk
Report to CPS – View Policy
- Use on-line portal
- Call CPS if either of the following:
  - Immediate safety concerns for discharge
  - Concern for other children in the home at risk
- Complete online portal within 48 hours of call
Note:
Clinicians with a concern for possible abuse are obligated to report to CPS even if the child is referred for further medical evaluation. Inform family of CPS report.

No CPS report indicated
Routine follow-up

Discharge Home

No concern for injuries requiring medical evaluation
No indications for occult injury evaluation
No immediate safety concerns

Referral to ED

Primary Care Referral Recommendations and Communications to ED
Concern for acute injuries requiring medical evaluation, treatment
Further occult injury screening needed
All Children < 2 yrs
Safety concerns

Posted: September 2018
Revised: November 2018
Authors: P. Scribano, MD; J. Wood, MD; K. Henry, MD; V. Scheid, MD; L. Palacio, LSW; C. Jacobstein, MD; J. Lavelle, MD

Related Links

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.