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

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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