Emergency department evaluation and management of nonaccidental trauma in pediatric patients.

Children who have suffered physical abuse may present to the healthcare setting multiple times before a diagnosis is made. Emergency clinicians must be able to recognize sentinel and severe signs of nonaccidental trauma and pursue an appropriate evaluation to prevent further injury. This issue offers evidence-based recommendations for the identification and management of nonaccidental trauma in children. Key historical and physical examination findings that should trigger an evaluation for physical abuse are reviewed. Recommendations are given for obtaining diagnostic studies and consulting with specialists. Guidance is provided for documenting and reporting findings when nonaccidental trauma is suspected.