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)