Either of the following present?
Full, age-appropriate screening for occult injuries in any other child in the home of the patient.
Social work (and child abuse expert if available) consult and report to proper authorities. Consider trauma specialist evaluation if any suspicion or signs of trauma present.
Suspicion of sexual assault?
Head injury or abnormal brain imaging?
Intracranial bleeding without trauma?
Detailed medical history (including social/family history and observations by other caregivers and medical providers) and physical exam.
Febrile or petechiae?
Extensive soft tissue bruising?
Urine organic acids, Hematology consult, Thrombophilia Panel (Homocysteine, Antithrombin III Activity, Factor VIIIC, Protein C Activity, Free Protein S Antigen, DRVVT, Lupus Anticoagulant, Lupus Anticoagulant Hexagonal Phase, Factor V Leiden, Prothrombin Variant 20210A)
Ophthalmology consult
Severe injuries or mental status changes?
< 12 months or developmentally delayed?
12-24 months or developmentally delayed?
Multiple fractures or bone deformities?
2- 6 years?
Consider sexual assult pathway
↑ LFTs, hematuria or abd. trauma?
Calcium, phosphorus, intact PTH, serum 25-hydroxy-vitamin-D
Multidiciplinary decision of admission, discharge and follow up. Consider re-evaluation and possible reimaging with x-rays in 2 weeks if concern for missed fractures.
Fracture specificity for abuse
High |
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Conditions that mimic abuse
Bruising |
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Fractures |
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Burns |
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Intracranial Hemorrhage |
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Indicators for Suspected Abuse
Behavioral clues
Symptom clues
Headaches
Physical clues
Skeletal Survey Xrays
APPENDICULAR SKELETON
AXIAL SKELETON
Pattern of bruises suggestive of abuse
Location
Consider workup for meningitis if symptomatic
CT or MRI head
If the patient presents with mental status changes or concerns for ingestion consider obtaining toxicology testing.
Hematology consult, Thrombophilia Panel (Homocysteine, Antithrombin III Activity, Factor VIIIC, Protein C Activity, Free Protein S Antigen, DRVVT, Lupus Anticoagulant, Lupus Anticoagulant Hexagonal Phase, Factor V Leiden, Prothrombin Variant 20210A)
Treat appropriately
Forensic evidence collection