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Carolinas Case Conference - Dr. S. Lawson

9/21/2017

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Picture
Working in a pediatric ED isn't just diagnosing viruses - child abuse/neglect is more prevalent than we'd like to think:
  • 2-10% of children presenting to the ED are victims of abuse or neglect
  • children that are abused often have multiple healthcare visits before it is recognized
 
Providers should be mindful of sentinel injuries - injuries without a plausible explanation
  • soft tissue injuries - bruising in children who cannot cruise, or in high risk areas
  • remember TEN-4 - ANY bruising in a child less than 4 months, or bruising on the Trunk, Ears, and Neck in a child less than 4 years
 
Skeletal injuries are the second most common presentation of abuse - certain fractures should raise your suspicion for abuse
  • rib fractures (make sure you check that CXR ordered to look for pneumonia)
  • any fracture in a child that cannot walk
  • long bone fractures in an infant or toddler
 
Abusive head trauma (formally known as “shaken baby syndrome”)
  • This is the most common cause of death following abuse
  • 30% of cases are missed initially – remember to consider it in cases of excessive fussiness or altered mental status
 
Chest and abdominal injuries
  • the abdomen can hide injuries and hold a lot of blood
  • elevated liver enzymes or lipase should raise your concern for occult intra-abdominal injury
 
What can you do to help prevent a missed diagnosis of abuse?
  • Perform a “top-toe” exam on every patient and examine their skin for bruising (this means everyone should be in a gown)
  • Make sure the explanation of the injury makes sense developmentally – “those who don’t cruise rarely bruise”
  • If you’re concerned about possible abuse, initiate a screening work up or admit the child to a service that can complete an abuse evaluation
  • Remember that you are a mandated reporter – involve Social Work early, even if you plan to refer the child to another hospital for evaluation.
 

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction