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Emergency department child abuse screening tools

Emergency department child abuse screening tools
Screening tool Age range Components
Escape tool* <6 to <14 years old, depending on institution
  • Inconsistent history
  • Delay in seeking help
  • Injury inconsistent with child's developmental level
  • Concerning interaction between child and parent/primary caregiver
  • Head to toe examination findings show injury implausible with history
  • Other concerns for safety
Two-question tool <6 years old
  • History inconsistent or unwitnessed, delay in seeking care, or other concern for abuse
  • TEN-4-FACEp bruising, fracture in a non-ambulatory child, or signs of head injuryΔ
One-question screen <5 years old
  • Is this an injured or trauma patient?◊
Complete skin examination by a nurse <2 years old
  • High risk bruise or any bruise in an infant <6 months old
This table provides examples of tools that have been implemented for universal screening of children presenting for care in an emergency department. For more information on a specific tool, please refer to UpToDate topics on recognition of physical child abuse and universal screening for child abuse.

* Tools related to the Escape tool include the Pittsburgh Child Abuse Screening Tool (P-CAST), SPUTOVAMO-R tool, and Finding Instrument for Non-accidental Deeds (FIND).

¶ Bruise on torso, ears, neck, bruising in an infant ≤4 months old (TEN-4); bruising of the frenulum, angle of jaw, check, eyelid, or subconjunctival hemorrhage (FACE); or patterned bruising (p). Many experts consider any bruise in an infant <6 months old concerning for abuse.

Δ Vomiting without fever or diarrhea, seizure-like activity, or bulging fontanel.

◊ All patients with positive screen underwent assessment by a multidisciplinary child abuse team before additional imaging or reporting to Child Protective Services.

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