Physical Abuse Clinical Pathway — Emergency Department

Screen for Occult Injury

  Head CT or MRI Skeletal Survey Abdominal & Pelvic CT Cervical Spine
MRI
0-12 months
  • Obtain CT if symptomatic
  • Consider CT if evidence of CHI on PE
    Schedule MRI for asymptomatic infants & admit for MRI
Yes
Obtain if symptomatic or
suggested by physical exam

Consult trauma for imaging recommendations if only finding is elevated enzymes.
Consider if concern for AHT.
12-24 months No Yes
Discuss with SCAN in cases of AHT or severe injuries
2-6 years No No*
7-18 years No No

*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

Laboratory Study Comments
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

PT/PTT

Add vWF antigen and activity, Factor VIII and IX levels if patient requires blood products

For bruising or intracranial hemorrhage
Drug Screening
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