Physical Abuse Clinical Pathway — Outpatient Specialty and Primary Care

Outpatient Specialty Care and Primary Care Pathway for Evaluation/Treatment of Children with Physical Abuse Concerns

Goals and Metrics
Patient Education
Provider Resources
Related Pathways
Scheduled Primary/Subspecialty Care Visit
 
 
Sibling Considerations
  • Siblings/children in household of child with abusive injuries are at increased risk.
  • Determine optimal evaluation for sibling risk. ED < 2 yrs, > 2 yrs primary care as able. Consult SCAN for recommendations.
 
 
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
  • No safety concerns
Findings Suggestive of Abuse
  • Witnessed or disclosed abuse
  • Injury pathognomonic for abuse
  • Injuries Suggestive of Abuse not explained by plausible mechanism
  • Multiple injuries
  • Suspicious occult injuries identified by patient workup
  • Note: Age < 6 mos with any injury warrants consideration of suspected abuse
 
 
 
 
Recommendations
  • No further workup for abuse
  • No CPS report indicated
  • Routine follow-up
  • Discharge home
Concern for Abuse
    • ED Referral
      • Age < 2 yrs with any concern for possible abuse
      • Findings suggestive of abuse requiring further evaluation
      • ED Physical Abuse Pathway
      • Historical or social concerns that require social work consult
      • Injury that requires further evaluation, treatment
      • Child accompanied by social services for abuse evaluation
    • CPS Referral for the Following
      • Reasonable suspicion for child maltreatment
    • Communication
      • PCP contacts referral line 215-590-2160
      • Speaks with EMCP as indicated, leaves cell number
      • Ensures child arrives at ED
      • CPS referral as indicated
Posted: September 2018
Revised: February 2025