Skip navigation; go directly to the content A-Z indexTable of contents
  
HomechaptersTriageHistoryPhysical ExaminationLaboratory Overview Testing for Sexually Transmitted Diseases Testing for Pregnancy Evaluation for Suspected Physical Injuries Failure to Thrive Toxicology Testing Additional Resources RadiologyDiagnosisDocumentationReportingFoster CareChildren and Adolescents with DisabilitiesJuvenile Sexualized BehaviorMultidisciplinary ApproachLegal IssuesAppendicesspacerAbout UsContactAcknowledgementsSupport and Endorsement  

LABORATORY: Evaluation for Suspected Physical Injuries

In physical abuse cases the laboratory is most commonly used to help determine the presence or extent of soft tissue injuries. If there is little suspicion of significant injury after performing the history and physical, laboratory testing tends to be of limited value.


Evaluation for a Bleeding Disorder
line spacer When child abuse is suspected and bruises are present, clotting studies to evaluate for abnormal bleeding and bruising should be routine. However, if there is pattern bruising, coagulation studies may not be necessary. A detailed workup by a hematologist may be required if there is a family or patient history of a bleeding disorder or abnormal results from a screening test. However, a clotting disorder does not rule out the possibility of abuse.

Recommendations for laboratory tests related to physical injury are listed below:

  • A screening panel that includes CBC, platelet count, PT, PTT, and PFA-100.
    • CBC to determine if there is a specific hematological abnormality
    • Platelet count because thrombocytopenia is the most common cause of bleeding
    • PT (Prothrombin Time) and PTT (activated Partial Thromboplastin Time) to test for deficiencies in clotting factors
    • PFA-100, a platelet function assay to measure platelet activity

  • The most common hereditary bleeding disorder is von Willebrand disease with a prevalence of approximately 1% of the population. It may present with recurrent epistaxis, mucocutaneous hemorrhage, menorrhagia and /or excessive bruising. Normal coagulation screens do not rule out the possibility of von Willebrand's disease, although the PTT may be prolonged. With repeated bruising, appropriate testing may include blood typing, von Willebran's factor and Ristocetin Cofactor activity, Factor VIII, and a platelet count.

  • Bleeding times are not recommended.

  • The INR (International Normalized Ratio) is used for the standardization of PT across laboratories and is not a screening for coagulation factors.

  • Children/adolescents with intracranial bleeding should also have factor VIII and factor IX levels tested if they are male. Congenital deficiency of factor VIII has an incidence of 1 in 5000 males and factor IX deficiency has an incidence of 1 in 30,000 males. With these factors, there is also an association with prolonged bleeding of the umbilical cord and other bleeding sites.



Evaluation for Visceral Injury
line line Abdominal trauma is particularly ominous as the signs and symptoms of significant pathology can initially be very subtle. A complaint of abdominal pain, soft tissue evidence of abdominal trauma, or evidence of hemodynamic compromise increases the index of suspicion for intra-abdominal injury. The following injures are commonly associated with abuse: pancreatic trauma, duodenal and proximal jejunal trauma, liver trauma and pharyngeal laceration without explanation. The recommended screening tests are listed below:

Liver

  • Alanine aminotransferase (ALT, SGPT)
  • Aspartate aminotransferase (AST, SGOT)

Pancreas

  • Amylase
  • Lipase

Kidneys

  • Urinalysis
    With physical abuse the most common use for this test is to evaluate for blood.

Bowel or rectum

  • Stool guaiac
    A positive test could help to determine occult rectal bleeding due to abdominal or anal trauma.

Remember that the diagnosis of trauma is generally based on clinical assessments, and exhaustive evaluations for other diagnoses are usually not medically relevant.

to top of page



 
 

 

line

© 2005-2018 All Rights Reserved
www.ChildAbuseMD.com champ@upstate.edu
SUNY Upstate Medical University
Syracuse, New York

line
 

Laboratory: Overview  Laboratory: Testing for Sexually Transmitted Diseases  Laboratory: Testing for Pregnancy  Laboratory: Evaluation for Suspected Physical Injuries  Laboratory: Failure to Thrive  Laboratory: Toxicology Testing  Laboratory: Additional Resources 

Home  Table of Contents  Triage  History  Physical Examination  Laboratory  Radiology  Diagnosis  Treatment and Follow-Up  Documentation  Reporting  Foster Care  Children & Adolescents with Disabilities  Juvenile Sexualized Behavior  Multidisciplinary Approach  Legal Issues  Appendices  About Us  Contact  Acknowledgements  Support & Endorsements  Site Index 
 



 

On this page:
Evaluation for a Bleeding Disorder
Evaluation for Visceral Injury