Faculty CME Session
January 25, 2017

1) Sentinel Injuries

SENTINEL INJURIES that are highly suggestive of abuse, though perhaps not significant clinically. These injuries may have nothing to do with the child’s current presentation.

  • Injuries in pre-cruising age children are of particular concern.
    • Most serious injuries/fatalities in abused children occur during infancy.
    • Any bruising to the torso, ears, or neck in a child under four months of age should be considered abuse.
  • Other high suspicion injuries include bruising to the groin, upper arm, lower back, buttocks, or any patterned injury in children of any age.
  • Injuries for which caregiver has a poor or non-existent explanation, or injuries where the history changes over time are highly suspect.

2) Reporting

  • You CAN NOT be sued for reporting a case of suspected abuse/neglect
  • When you do report:
    • Avoid qualitative statements about the family in your chart. Parents who have abused their children will appear concerned.
    • Don’t attempt to “date” injuries or bruises. Evidence shows we are inaccurate, and such statements can impede investigation/prosecution.
    • Describe injuries or bruises, measure them. Avoid diminutive terms in chart, such as “small bruise” — these ban bias investigators.
    • Be clear in your language, keeping in mind potential investigators are NOT medical professionals.

3. Medical Work-up

  • Work up for occult injury can be time consuming and difficult to complete at under-resourced hospitals.
    • Skeletal survey has replaced “babygram.” May not be available at all facilities or may have restricted hours.
    • Ophtho exam
    • CT/MRI
    • Labs in some cases, including work-up for thrombophilia can be necessary
  • Involve the Beacon Child Protection team
    • They are available 24/7 and can help guide the work up.
    • Can arrange follow-up and assist with the reporting process.
    • Posters will be up around ED outlining the appropriate approach to suspected abuse.