This is not something that any of us wants to evaluate in the Emergency Department, but it is a necessary part of the job.

First, look for suspicious or atypical bruises:

A case control study of 95 PICU trauma patients under the age of 4 showed that:

Bruises on the torso, ear, or neck for a child ≤4 years of age and

Bruising in any region for an infant <4 months of age were predictive of abuse

These were 97% sensitive and 84% specific for predicting abuse.

Then, initiate the following workup if non-accidental trauma:

Social Work consult

Skeletal survey if <3 years of age

Head CT if:

<6 months

Head/facial bruising

Labs to screen for intraabdominal injury

AST, ALT, Lipase, CBC, PT, PTT

Abdominal CT if:

Abdominal bruising is present

And/or if AST and/or ALT >80

Troponin-i for >3 months of age if: