It could have been different

***Trigger warning: this episode includes discussion of child abuse***

As emergency physicians, we are uniquely positioned to identify and address child abuse, or non-accidental trauma (NAT). It’s a challenging part of our job, but our vigilance can save a child’s life. Signs of abuse can often be subtle, but there are some very specific findings that should make us consider NAT. In this episode, we talk with expert, Dr. Mary Clyde Pierce, about her recently published paper, coauthored by our own Dr. Julia Magaña, validating the TEN-4 FACESp clinical decision rule to predict abuse in young children. 

Have you used TEN-4 FACESp to identify potential non-accidental trauma? Share your experience with us via social media, @empulsepodcast, or through our website,

***Please rate us and leave us a review on iTunes! It helps us reach more people.***


Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis

Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis


Dr. Mary Clyde Pierce, Professor of Pediatrics at Northwestern University, Pediatric Emergency Physician and Director of Child Abuse Research at Laurie Children’s Hospital.


Pierce MC, Kaczor K, Lorenz DJ, Bertocci G, Fingarson AK, Makoroff K, Berger RP, Bennett B, Magana J, Staley S, Ramaiah V, Fortin K, Currie M, Herman BE, Herr S, Hymel KP, Jenny C, Sheehan K, Zuckerbraun N, Hickey S, Meyers G, Leventhal JM. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Netw Open. 2021 Apr 1;4(4):e215832. doi: 10.1001/jamanetworkopen.2021.5832.

Lorenz DJ, Pierce MC, Kaczor K, Berger RP, Bertocci G, Herman BE, Herr S, Hymel KP, Jenny C, Leventhal JM, Sheehan K, Zuckerbraun N. Classifying Injuries in Young Children as Abusive or Accidental: Reliability and Accuracy of an Expert Panel Approach. J Pediatr. 2018 Jul;198:144-150.e4. doi: 10.1016/j.jpeds.2018.01.033. Epub 2018 Mar 15. PMID: 29550228; PMCID: PMC6019119.

CDC Morbidity and Mortality Weekly Report: Trends in US Emergency Department Visits Related to Suspected or Confirmed Abuse and Neglect Among Children and Adolescents Aged <18 Years Before and During the COVID-19 Pandemic – United States, January 2019-September 2020


Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

2 thoughts on “It could have been different

  1. Hi EM Pulse!

    Thank you for the great podcast and a hugely important topic and special thanks to Dr Pierce for doing this very impactful research! I have two comments/questions about the episode:

    – Regarding the “4 and down in a gown” approach, realistically, what do you think about the feasibility of such a policy? Does UC Davis PED do this for every child under 5? Looking at the numbers, out of a 100 patients, you would find bruises in 10 and maybe 2 of those would be due to abuse (assuming similar baseline prevalence in the population). 40% of abuse occurred in children less then 1 year where the norm is to take off all clothes including diapers for the physical exam. I am wondering about the added benefit of unclothing all 1-4 year olds. Notably, just doing a normal “medical” phyical (HEENT & listen to the chest) would provide access to almost all relevant body parts. Of course the trick is to have abuse in your mind when doing a medical physical, but I am wondering whether this “4 and down in a gown” approach is the best way to get there realistically.

    – You have mentioned that you collected a very detailed history from all participating children. Did you consider applying some of the other abuse screening tools to see how well they combine with the physical exam findings, such as the SPUTOVAMO checklist?

    Many thanks again for the great work and a very high-yield podcast!
    Best regards,

    Aron Kerenyi
    Senior Resident in Pediatrics
    Astrid Lindgrens Children’s Hospital
    Karolinska University Hospital
    Stockholm, Sweden

Leave a Reply

%d bloggers like this: