Sentinel Injuries

Curbside Key Points

CHAMP Education for Child Abuse Medical Providers

  • Sentinel injuries are medically minor but are suspicious for abuse and therefore have potential forensic significance.
  • The most common sentinel injury is bruising.
  • Bruising in pre-mobile children is uncommon and should prompt a thorough history and exam.
  • TEN-4-FACESp is a validated clinical decision rule used to predict abuse.
  • Consider biases during the evaluation.
  • Non-accidental trauma protocols (including reporting to social services) can help mitigate some biases.

Accessible Version

I'd like to end with some key points. I know that you've heard now a few times my definition or the definition of sentinel injuries. I will restate it here. They are medically minor injuries, but suspicious for abuse and therefore have potential forensic significance. The most common type of sentinel injury by far and away is bruising. I think we also reviewed that bruising in a pre-mobile child is uncommon and therefore should prompt a thorough history and physical exam. And here in this area, you'll see that I said pre-mobile child. So I consider this any child who's not able to pull to a stand and cruise. If they have a bruise, I am concerned about physical abuse in that group of kids, so I base my assessment on their developmental age, not necessarily their chronological age. We also discussed 10-4- faces P, which is a validated clinical decision rule used to predict abuse. I shared and reviewed a number of biases that can occur during an evaluation. And we recognize that protocols including a protocolized approach to reporting to social services can help mitigate some of these biases.