Paeds Cases · child-safety-and-social-paediatrics
Sentinel injury OSCE — recognising inflicted bruising in the non-mobile infant
Observed structured encounter testing recognition of inflicted bruising, the TEN-4 FACES-L rule, the bleeding-disorder differential and the safeguarding pathway.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Station A is a non-mobile infant with an unexplained ear bruise. Station B is a toddler with multiple high-specificity bruises and a normal coagulation screen.
Station objectives
- Recognise a discriminating bruise and a sentinel injury in a non-mobile infant. [3] [2]
- Apply the TEN-4 FACES-L rule and justify an abuse evaluation. [1] [5]
- Construct and run the appropriate investigation and safeguarding pathway. [4]
- Communicate with the family without accusation while completing the mandatory pathway. [4]
References8ShowHide
- [1]Pierce MC Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics, 2010.PMID 19969620
- [2]Sheets LK Sentinel injuries in infants evaluated for child physical abuse. Pediatrics, 2013.PMID 23478861
- [3]Sugar NF Bruises in infants and toddlers: those who don't cruise rarely bruise. Puget Sound Pediatric Research Network. Archives of pediatrics & adolescent medicine, 1999.PMID 10201724
- [4]Christian CW The evaluation of suspected child physical abuse. Pediatrics, 2015.PMID 25917988
- [5]Pierce MC Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA network open, 2021.PMID 33852003
- [7]Letson MM Prior opportunities to identify abuse in children with abusive head trauma. Child abuse & neglect, 2016.PMID 27680755
- [9]Maguire S Diagnosing abuse: a systematic review of torn frenum and other intra-oral injuries. Archives of disease in childhood, 2007.PMID 17468129
- [11]Hultman L Testing for bleeding disorders in child abuse: AAP recommendation adherence and testing results. Child abuse & neglect, 2025.PMID 40158474