Appendices : Appendix E
Differential Diagnosis Table
Clinical Findings
Differential Diagnosis
Differential Tests
CUTANEOUS LESIONS
Bruising
Trauma
Rule out other disease
Hemophilia
Prothrombin time, partial prothromboplastin time
Von Willebrand's disease
Von Willebrand's panel
Henoch Schonlein purpura
Typical distribution of lesions
Purpura fulminans
Rule out sepsis
Ehlers-Danlos syndrome
Hyperextensibility
Local erythema or bullae
Burn
Clinical history and characteristics
Staphylococcal impetigo
Culture, Gram stain
Bacterial cellulitis
Culture, Gram stain
Pyoderma gangrenosum
Culture, Gram stain
Photosensitivity and phototoxicity reactions
History of sensitizing agent, oral or topical reactions
Frostbite
Clinical history and characteristics
Herpes, zoster or simplex
Scraping, culture
Epidermolysis bullosa
Skin biopsy
Contact dermatitis, allergic or irritant
Clinical characteristics
OCULAR FINDINGS
Retinal hemorrhage
Shaking or other trauma
Bleeding disorder
Coagulation studies
Neoplasm
Resuscitation
History
Conjunctival hemorrhage
Trauma
Culture, Gram stain
Bacterial or viral conjunctivitis
History
Severe coughing
Orbital swelling
Trauma
Orbital or periorbital cellulitis
Complete blood count, culture, sinus radiographs
Metatastic disease
Radiograph, CT scan, CNS examination
Epidural hematoma
Radiograph, CT scan, CNS examination
HEMATURIA
Trauma
Rule out other disease
Urinary tract infection
Culture
Acute or chronic forms of glomerular injury (e.g., glomerulonephritis)
Renal function tests, biopsy
Hereditary or familial renal disorders (e.g., familial benign recurrent hematuria)
History
Other (e.g., vasculitis, thrombosis, neoplasm, anomalies, stones, bacteremia, exercise)
History, cultures, radiologic studies
ACUTE ABDOMEN
Trauma
Rule out other disease
Intrinsic gastrointestinal disease (e.g., peritonitis, obstruction, inflammatory bowel disease, Meckel's diverticulum)
Radiographs, stool tests, and others
Intrinsic urinary tract disease (infection, stone)
Culture, ultrasound, intravenous pyelogram
Genital problems (e.g., torsion of spermatic cord, ovarian cyst)
History, physical examination, ultrasound, radiograph, laparoscopy
Vascular accident, as in sickle cell crisis
Angiography, sickle cell studies
Other (e.g., mesenteric adenitis, strangulated hernia, anaphylactoid purpura, pulmonary disease, pancreatitis, lead poisoning, diabetes)
As appropriate
OSSEOUS LESIONS
Fractures (multiple or in various stages of healing)
Trauma
Osteogenesis imperfecta
Radiographic and blue sclerae
Rickets
Nutritional history
Birth trauma
Birth history
Hypophosphatasia
Decreased alkaline phosphatase
Leukemia
Complete blood count, bone marrow
Neuroblastoma
Bone marrow, biopsy
Status after osteomyelitis or septic arthritis
History
Neurogenic sensory deficit
Physical examination
METAPHYSEAL LESIONS, EPIPHYSEAL LESIONS, OR BOTH
Trauma
Scurvy
Nutritional history
Menkes syndrome
Decreased copper, decreased ceruloplasmin
Syphilis
Serology
"Little League" elbow
History
Birth trauma
History
SUBPERIOSTEAL OSSIFICATION
Trauma
Osteogenic malignancy
Radiograph and biopsy
Syphilis
Serology tests
Infantile cortical hyperostosis
No metaphyseal irregularity
Osteoid osteoma
Response to aspirin
Scurvy
Nutritional history
SUDDEN INFANT DEATH SYNDROME
Unexplained death
Autopsy
Trauma
Autopsy
Asphyxia (aspiration, nasal obstruction, laryngospasm, sleep apnia)
"Near-miss" history
Infection (e.g., botulism)
Cultures, bacterial and viral
Immunodeficiency
Immunoglobulins
Cardiac arrhythmia
Autopsy
Hypoadrenalism
Electrolytes, ACTH stimulation test
Metabolic abnormality
Ca++, Mg++, other
Hypersensitivity to cow's milk protein
Adapted from Newberger EH. Child physical abuse. Primary Care. 1993; 20 (2) : 317-27.
Source: Vandeven A and Knight JR. Physical Abuse: The Father’s Handprint, Handout #1: Differential Diagnosis of Child Abuse. In: Knight JR, Frazer C, Emans SJ, eds. Bright Futures Case Studies for Primary Care Clinicians: Child Development and Behavior. Boston, MA: Bright Futures Center for Education in Child Growth and Development, Behavior, and Adolescent Health; 2001.
