Emergency Department Evaluation and Management of Nonaccidental Trauma in Pediatric Patients (Trauma CME)

Enlarge Image
Delivery Method:	Online
$99.00 ADD TO CART OR SUBSCRIBE AND SAVE Back To Store

Publication Date: September 2023 (Volume 20, Number 9)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 09/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credit, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Children who have suffered physical abuse may present to the healthcare setting multiple times before a diagnosis is made. Emergency clinicians must be able to recognize sentinel and severe signs of nonaccidental trauma and pursue an appropriate evaluation to prevent further injury. This issue offers evidence-based recommendations for the identification and management of nonaccidental trauma in children. Key historical and physical examination findings that should trigger an evaluation for physical abuse are reviewed. Recommendations are given for obtaining diagnostic studies and consulting with specialists. Guidance is provided for documenting and reporting findings when nonaccidental trauma is suspected.

Case Presentations

A 2-month-old boy is brought to the ED by his mother for lethargy and a seizure at home…

• The mother states that earlier that day the child had been fussier than usual, then he had a seizure lasting about 3 minutes. Since the seizure, the child has been very sleepy.
• The boy’s temperature and vital signs are normal. On examination, the infant appears lethargic, with poor tone. He vomits once in the ED.
• What is on your differential for this patient? What are the next steps in management?

A 13-month-old boy is brought to the ED by his grandmother for 3 days of fever and runny nose...

• On examination, the child has a fever of 38.2°C, rhinorrhea, bilateral tympanic membrane erythema, and a 1-cm bruise to the pinna of the left ear.
• What other workup is indicated at this time? Is the bruise likely an accident? Does this warrant a Child Protective Services referral?

A 5-month-old girl is brought to the ED by her babysitter after falling earlier in the day…

• The babysitter says the child was pulling to stand on a coffee table then fell down and has been inconsolable since.
• On examination, the child cries when you palpate her right lower extremity.
• You wonder whether this injury make sense for the child’s age...

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.