Pless et al describe a screening instrument for children presenting to the Emergency Department at the Montreal Children's Hospital. This can help identify a child whose injuries may have been caused by abuse or neglect.


The instrument consists of 10 questions:

(1) 3 about the patient

(2) 5 about the parent or caregiver

(3) 2 answered by the physician



• Evidence of repeated injury may include multiple injuries in different stages of resolution.



• The presence of one or more positive responses should prompt further evaluation of the child.

• After further investigation, cases were classified as:

(1) nonaccidental injury: injuries known or firmly believed to have been inflicted on the child

(2) gross neglect: severe deprivation of physical, psychological, nutritional, medical or safety care of a child, or a combination of these, leading to failure to meet expected milestones of growth and development.

(3) high risk: injury or harm to a child resulting from possible, but unproven, abuse or neglect

(4) true accident: an unpremeditated event resulting in recognizable injury or harm



• The presence of one or more positive responses does not mean that abuse has occurred. As with any screening instrument, the goal is to be quick and sensitive at the expense of specific.


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