Clinical Screening Tools for Child Maltreatment

Download this page as a PDF file

Clinical Tool

Intended Population

Exclusion Criteria


Validation Study Results

Pediatric Brain Injury Research Network (PediBIRN)

Children under 3 years of age admitted to the
pediatric ICU with an acute, closed, traumatic cranial or intracranial
injury; tool now also validated in an ED setting

  • Imaging reveals “pre-existing brain
    malformation, disease, infection, or hypoxia-ischemia”
  • Injuries resulting from a motor vehicular collision


The 4 variables used were: 

  • Clinically significant respiratory
    compromise any time prior to admission;
  • Bruising of the torso, ears, neck;
  • Subdural hematoma or fluid bilaterally and/or in the interhemispheric fissure;
  • Any skull fracture except a parietalfracture that is isolated, unilateral, nondiastatic, linear

When more than 1 variable was present, the sensitivity
was 96% and the specificity was 46%

External Validation of the PediBRN Screening Tool for Abusive Head Trauma in Pediatric Emergency Department Settings

Predicting Abusive Head Trauma (PredAHT)

Hospitalized children under 3 years old presenting
with an intracranial injury

Cases where etiology of injury was deemed

6 features are used in the tool: head or neck
bruising, seizure, apnea, rib fracture, long bone fracture, retinal

With more than 3 features present, sensitivity was
72.3% and specificity was 85.7%

Pittsburgh Infant Brain Injury Score (PIBIS)

Well appearing infants (i.e. less than 1 year of age)
presenting to an ED with no history of trauma and a high-risk sign or symptom
(e.g., acute life-threatening event [ALTE]/ brief resolved unexplained event
[BRUE], seizure, vomiting without diarrhea, irritable, bump on scalp,

Having a previously abnormal head computed tomography

The 5-point PIBIS scale is weighted: 2 points for
abnormality on dermatologic exam (e.g., bruising); 1 point for age above 3
months, head circumference above 85%, or serum hemoglobin under 11.2 g/dL

In patients with a score of 2 or greater, sensitivity
of the test for identification of abnormal intracranial imaging was 93% and
specificity was 53%

Bruising Clinical Decision Rule  

A screening tool for physical abuse in children with

Children under 4 years of age with bruising evaluated
in an ED/hospital setting



Bleeding disorder, motor vehicle crash, severe
spasticity, no bruising

  • TEN”: Bruising on Torso (chest, abdomen, back, buttocks, genitourinary region, and hip), Ears,
  • Any bruising in infants months old and younger
  • “FACES” bruising on Frenulum, Angleof jaw, Cheek, Eyelids, subconjunctivae; p for patterned


96% sensitive, 87% specific for predicting abuse in
children with bruising, and an abuse work-up may be warranted