To refer a patient to Connecticut Children’s, contact the OneCall team:

Suspected Physical Abuse (SPA)

Pathway Background and Objectives

In 2013 there were close to 70,000 substantiated cases of child abuse and neglect in the United States. Child maltreatment is a significant medical problem. Cases of suspected physical abuse frequently present to the emergency department. It has been noted that there is variation in case evaluations among providers. There are also many providers who are unsure of how to evaluate cases of suspected physical abuse. There are guidelines set by the American Academy of Pediatrics for the evaluation of suspected cases of non-accidental trauma.

The objectives of this pathway are to:

  • Standardize the clinical practice in cases of suspected physical abuse that present to Connecticut Children’s
  • Standardize initial work-up and history taking
  • Provide clear guidelines for when to consult with the Suspected Child Abuse and Neglect (SCAN), Pediatric Surgery, Neurosurgery, Orthopedic, and Ophthalmology teams
  • Provide clear, evidence based guidelines for ordering laboratory and radiographic testing when abuse is suspected
  • Decrease the ordering of unnecessary imaging studies
  • Reduce bias in the evaluation of suspected child physical abuse cases


Download SPA Pathway Algorithm

Quality Metrics

  • Percentage of patients with suspected physical abuse who have SCAN consult order
  • Percentage of patients < 2 years old with suspected physical abuse who have skeletal survey ordered
  • Percentage of patients with suspected physical abuse who have utilization of the pathway order set
  • Length of stay (days) for admitted patients
  • Percentage of admitted patients who had pediatric surgery consult order
  • Percentage of patients with maltreatment ICD-10 code applied

Educational Module

Download SPA Educational Module

Key References

Anderst JD, Carpenter SL, Abshire TC; Section on Hematology/Oncology and Committee on Child Abuse and Neglect of the American Academy of Pediatrics. Evaluation for bleeding disorders in suspected child abuse. Pediatrics. 2013 Apr;131(4):e1314-22.

Baxter AL, Lindberg DM, Burke BL, Shults J, Holmes JF.  Hepatic enzyme decline after pediatric blunt trauma. Child Abuse Negl. 2008 Sep;32(9):838-45.

Child Maltreatment 2013. U.S. Department of Health and Human Services Administration for Children and Families.

Christian CW; Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse.  Pediatrics. 2015 May;135(5):e1337-54.

Leventhal JM, Gaither JR. Incidence of Serious Injuries Due to Physical Abuse in the Unites States: 1997 to 2009. Pediatrics. 2012 Nov;130(5):e847-52.

Lindberg D, Makoroff K, Harper N, Laskey A, Bechtel K, Deye K, Shapiro R; ULTRA Investigators. Utility of hepatic transaminases to recognize abuse in children. Pediatrics. 2009 Aug;124(2):509-16.

Flaherty EG, Perez-Rossello JM, LevineMA , Hennrikus WL, and the American Academy of Pediatrics Committee on Child Abuse and Neglect, Section on Radiology, Section on Endocrinology, and Section on Orthopaedics, and The Society for Pediatric Radiology. Evaluating children with fractures for child physical abuse. Pediatrics. 2014 Feb;133(2):e477–e89.

Rubin DM, Christian CW, Bilaniuk LT, Zazyczny KA, Durbin DR. Occult head injury in high-risk abused children. Pediatrics. 2003 Jun;111(6 Pt 1):1382-6.

Pathway Contacts

Nina Livingston, MD
Mike Soltis, MD
Rebecca Moles, MD


The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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