Physical Abuse Clinical Pathway — Emergency Department

Screen for Occult Injuries, Medical Conditions

Conditions Mistaken for Bruising

  • Mongolian spots
  • Coining
  • Erythema nodosum
  • Ink, paint, dye
  • Cupping
  • Phytophotodermatitis

Conditions that May Predispose a Child to Bruising

  • HSP
  • ITP
  • Leukemia
  • DIC
  • Hemophilia
  • Ehlers-Danlos
  • Hemangioma
  • Vitamin K deficiency
  • Inherited coagulopathies

Conditions Mistaken for Burns

  • Impetigo
  • Severe diaper rash
  • Frostbite
  • Chemical burns
  • Epidermolysis bullosa
  • Phytophotodermatitis
  • Ingestion of ex-lax causing buttock “burns”
  • Moxibustion

Conditions that May Predispose a Child to Intracranial Hemorrhage

  • Glutaric aciduria type 1 (associated findings: macrocranium, subdural hematomas, retinal hemorrhages, frontotemporal atrophy)
  • Hemorrhagic disease of the newborn
  • Inherited coagulopathies
  • Acquired coagulopathies
  • Arteriovenous malformation

Conditions that May Predispose a Child to Fractures

  • Osteogenesis Imperfecta (variable associated findings: blue sclera, ligamentous laxity, wormian skull bones, hearing loss. Usually inheritance is autosomal dominant)
  • Osteopenia of prematurity
  • Florid rickets (vitamin D (25 OH) < 10 and radiographic findings of rickets)