Boos, Stephen, MD

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Scholarly Commons @ Baystate Health

 Author:    Stephen Boos, MD                   Co-Medical Director, FAC      February 2017 Contact:   Baystatechildren’shospital@baystatehealth.org PRACTICAL PEARL: SCREENING for CHILD ABUSE  INTRODUCTION  The hardest job is thinking the unthinkable. A simple, memorable “hip pocket rule” that alerts a clinician in that moment is the clinical decision rule TEN-4.  INITIAL EVALUATION AND MANAGEMENT BY PRIMARY CARE   Use TEN-4 for children under 4-years-old: a bruise on the Trunk, Ear, or Neck (TEN) needs evaluation  OR, on a child under 4-months-old, any bruise needs to be evaluated for child abuse.  In its PICU derivation, TEN-4 had a sensitivity of 97% and a specificity of 84%.  WHEN TO REFER  All children identified by TEN-4 need consultation.  If you think that your patient is an exception, run your reasoning through another clinician.  Report to DCF and arrange an appropriate medical assessment for occult injury and underlying medical fragility.  These situations are urgent.  Though it is “only a bruise”, it can be an unpredictable, potentially fatal situation.  HOW TO REFER  Direct referral to the Baystate Pediatric Emergency Department is sometimes necessary.  Medical consultation is available from the Baystate Child Abuse Pediatrician.  Call the Family Advocacy Center social worker at (413) 794-5070 or page through the Baystate operator (413) 794-0000  DCF Hotline numbers is (800) 792-5200, or call your local office.  WHAT TO EXPECT FROM BAYSTATE CHILDREN’S HOSPITAL VISIT  Baystate team will show your patient’s family respect, abuse or not.  Children are often admitted to preserve parent-child contact during evaluation.  Thorough evaluation of both abuse and alternative possibilities.  When necessary, we will work with DCF and the courts to protect the child’s interests.   

Practical Pearl: Screening for Child Abuse -  Feb. 2017

https://scholarlycommons.libraryinfo.bhs.org/cgi/viewcontent.cgi?article=1013&amp;context=pedipearl

Practical Pearl: Screening for Child Abuse - Feb. 2017

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Scholarly Commons @ Baystate Health