Emergency Department Clinical Pathway for Evaluation/Treatment
of Children with Concern for Physical Abuse
ED Team Assessment
-
History and Physical Exam
- History Concerning for Abuse
- Care of Siblings
- Injuries Suggestive of 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
Findings with Low Concern for Abuse
- Single injury with plausible accidental mechanism, but social concerns
- or
- Isolated linear skull fracture in infant
> 4 mos with plausible mechanism - or
- Historical/social concerns for possible abuse without identified injury
Findings Suggestive of Abuse
- Witnessed or disclosed abuse
- Injury pathognomonic of abuse
- Injuries Suggestive of Abuse not explained by plausible mechanism
- Occult injuries identified
No occult injuries on skeletal survey
No concerns for abuse on full assessment
Social Work Consult
Skeletal Survey Recommendations
Skeletal Survey Recommendations
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 children with acute injury, admit to trauma or appropriate surgical service
Admitting Service Selection for Trauma Patients Job Aid
- Any children with acute injury, admit to trauma or appropriate surgical service
- General Pediatrics Admission
- Children requiring medical evaluation or safety planning
- Trauma Admission
- Consider:
KOPH Considerations
- Admit KOPH
- Safety planning, determining disposition needed
- Age > 2 yrs with isolated orthopedic injury
- Transfer to PHL
- Trauma Consult required