Physical Abuse Clinical Pathway — Emergency Department
Screen for Occult Injury
|Head CT or MRI||Skeletal Survey||Abdominal & Pelvic CT||Cervical Spine
Obtain if symptomatic or
suggested by physical exam
Consult trauma for imaging recommendations if only finding is elevated enzymes.
Consider if concern for AHT.
Discuss with SCAN in cases of AHT or severe injuries
*In rare cases, skeletal survey may be recommended by the SCAN team in Children aged 2-3 yo.
Cervical spine MRI should be considered in patients with abusive head trauma. Discuss need with SCAN and Trauma after admission.
Laboratory Testing for Occult Injuries & Medical Conditions
|CBC, CMP, Amylase, Lipase, UA||All patients less than 7 yrs; greater than 7 years if clinically indicated|
|Add Ca, Mg, Phos, Alk Phos, intact PTH, 25 Hydroxyvitamin D||For fractures, excluding skull fractures|
Add vWF antigen and activity, Factor VIII and IX levels if patient requires blood products
|For bruising or intracranial hemorrhage|
|CHOP and HUP Urine Drug Screens||Concern for drug ingestion or exposure|
MISC order to HUP for opiate confirmatory assay
Notify HUP at 215-662-3474
|Concern for opiate exposure|
|MISC designer drug test to ARUP||Concern for designer drugs|