Abusive Partner (Domestic Violence)
- Often, battered partners minimize injuries or seriousness of situation.
- Repeated visits to ED with increasing severity of injuries.
- Overprotective partner who refuses to leave Pt alone with staff.
- Signs of trauma consistent with physical and sexual assault.
- Unlikely mechanism of injury (story not matching injury).
- Details of injury changing from person to person.
- Burns (scalding or cigarettes) or wire marks.
- Fractures or dislocations in a child <2 yr old.
- Multiple injuries in various stages of healing.
- Unexcused delay in seeking medical attention.
- History inconsistent with child's developmental stages.
- Overly protective parent (interferes with assessment).
- Unusual fear of parent or desire to please parent.
- Withdrawn or aggressive behavior.
- Malnutrition, insect infestation, or disheveled appearance.
- Malnourishment and unexplained dehydration.
- Poor hygiene (body/clothing soiled with urine and feces).
- Clothing inappropriate for weather/season.
- Inappropriate use of restraints (bruising/abrasions of wrists and ankles).
Sexual Abuse (Child Molestation)
- Bruised or bleeding genitalia or blood-stained underwear.
- Painful urination or itching of genital area.
- STD or pregnancy.
- Inappropriate display of sexual behavior.
- Remove victim from abusive environment.
- Avoid any confrontation with alleged abuser.
- Avoid examining genitalia except to control hemorrhage.
- Sexual assault victims should be seen at a facility with staff trained and equipped for examining and collecting sexual assault evidence; they should not bathe, douche, urinate, or change clothes before being examined.
- Notify appropriate authorities or protective services when abuse is suspected.