A 3-year-old girl is brought to the emergency department by her mother with a chief
complaint of abdominal pain for 2 hours. Fever, vomiting, and diarrhea are denied by
the mother, who has been drinking alcohol. Vital signs are blood pressure 86/40
mmHg, pulse 130 beats per minute, respirations 24 per minute, temperature 37°C, and
room air oxygen saturation 100%. The child's abdomen is distended and tender. A
contusion is visible in the right upper quadrant, and bowel sounds are diminished.
Older bruises are seen on the upper arms, anterior thighs, and buttocks. A screening
ultrasound reveals fluid between the liver and the kidney. The mother denies trauma
but becomes very tearful. An IV is started, and blood is sent to the laboratory.
What is the next MOST appropriate sequence of events?
(A) Consult surgery, and contact social services.
(B) Ask the child what happened, consult surgery, and contact social services.
(C) Contact social services, then consult surgery.
(D) Contact surgery, and notify law enforcement directly.
The answer is B
In cases of suspected child abuse it is important and
useful to ask the child what happened and to record the response verbatim.
Regardless of the child's answer, her intra-abdominal injury takes immediate
priority, so consult surgery, then social services. The EP is obligated to report
all cases of suspected child abuse. Most EDs have social services workers to
facilitate notification of child protective services, which would coordinate any
immediate need for law enforcement. Along with head injuries, intra-abdominal
injuries are the two most common causes of death from child abuse. Abdominal
symptoms include pain, tenderness, vomiting, decreased bowel sounds, and distension.
Obvious trauma may be absent or denied historically. Potential injuries include
duodenal hematoma, hepatic or splenic rupture, intestinal perforation, traumatic
pancreatitis, renal trauma, and ruptured intra-abdominal blood vessels.
complaint of abdominal pain for 2 hours. Fever, vomiting, and diarrhea are denied by
the mother, who has been drinking alcohol. Vital signs are blood pressure 86/40
mmHg, pulse 130 beats per minute, respirations 24 per minute, temperature 37°C, and
room air oxygen saturation 100%. The child's abdomen is distended and tender. A
contusion is visible in the right upper quadrant, and bowel sounds are diminished.
Older bruises are seen on the upper arms, anterior thighs, and buttocks. A screening
ultrasound reveals fluid between the liver and the kidney. The mother denies trauma
but becomes very tearful. An IV is started, and blood is sent to the laboratory.
What is the next MOST appropriate sequence of events?
(A) Consult surgery, and contact social services.
(B) Ask the child what happened, consult surgery, and contact social services.
(C) Contact social services, then consult surgery.
(D) Contact surgery, and notify law enforcement directly.
The answer is B
In cases of suspected child abuse it is important and
useful to ask the child what happened and to record the response verbatim.
Regardless of the child's answer, her intra-abdominal injury takes immediate
priority, so consult surgery, then social services. The EP is obligated to report
all cases of suspected child abuse. Most EDs have social services workers to
facilitate notification of child protective services, which would coordinate any
immediate need for law enforcement. Along with head injuries, intra-abdominal
injuries are the two most common causes of death from child abuse. Abdominal
symptoms include pain, tenderness, vomiting, decreased bowel sounds, and distension.
Obvious trauma may be absent or denied historically. Potential injuries include
duodenal hematoma, hepatic or splenic rupture, intestinal perforation, traumatic
pancreatitis, renal trauma, and ruptured intra-abdominal blood vessels.
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