April 2014Vol. 15, No. 4Assessing Child Sexual, Physical Abuse
Injuries resulting from child abuse sometimes go unrecognized and misdiagnosed. According to Suspected Child Abuse: Clinical Practice Guideline (CPG), released by the Cardinal Glennon Children's Medical Center in order to reduce the possibility of misdiagnosis, there must be a high index of suspicion in the right clinical situation, as well as strong assessment tools to evaluate children. The CPG outlines the steps and responsible personnel for the assessment process and outlines the clinical pathways (i.e., guidance on clinical studies and consultations that may be conducted and/or ordered if abuse is suspected) to assist in the evaluation process.
The clinical pathways include documents addressing physical abuse and sexual abuse. The physical abuse materials are divided into three separate documents organized by the age range of the child, including birth to 2 years of age, 2 years of age to 5 years, and children older than 5. The suggested evaluations and consultations include varied skeletal surveys, computed tomography (CT) scans, ophthalmological studies, lab studies, and radiological studies.
The clinical pathways sexual abuse materials include documents that address the collection of sexual assault evidence of prepubertal and postpubertal victims of acute sexual assault (assault occurring less than 72 hours prior to presentation), subacute sexual assault (assault occurring between 72 hours and 2 weeks prior to presentation), and nonacute sexual assault (assault occurring greater than 2 weeks prior to presentation), as well as ongoing sexual assault. In addition, guidelines for acute rape prophylaxis and HIV postexposure prophylaxis (the provision of antiretroviral drugs to prevent HIV) are included.
Suspected Child Abuse: Clinical Practice Guideline (CPG) from the Cardinal Glennon Children's Medical Center, is available here:
http://www.cardinalglennon.com/Documents/emergency-medicine/child-abuse-clinical-practce-guidelines_for-professionals.pdf (1 MB)