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 injury^Δ
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.

Graphic 147541 Version 1.0

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Emergency department child abuse screening tools