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Summary of recommended investigations


  • Forensic investigations of suspicious injuries

     Condition

     Suggested investigations*

    Bruising 

    First line: FBE, PT/INR, APTT, Fg

    Second line: LFTs, U&E, Creatinine, Calcium, VWD screen with blood group, Factor VIII and IX levels

    Additional investigations are sometimes warranted and should be discussed with VFPMS and/or haematologist as appropriate

    Fractures 

    Calcium, Phosphate, Magnesium, Alkaline Phosphatase, PTH, LFTs, U&E, Creatinine

    Consider:

    25OH Vitamin D if child <6months or suspicion of rickets

    Septic work-up and inflammatory markers if possible osteomyelitis

    Copper and ceruloplasmin levels if child at risk for copper deficiency

    Vitamin C level (contact pathology staff to ensure adequate sample is provided) if child at risk of scurvy

    Syphilis serology in the presence of subperiosteal new bone formation or any other suggestive clinical signs

    Genetic testing for Osteogenesis Imperfecta (OI) or connective tissue disease if clinically indicated

     

    Intracranial bleeding (suspected AHT)

     

    FBE, INR, APTT, Fg, LFTs, U&E, Creatinine, Calcium, VWD screen with blood group, Factor VIII and IX levels

    Radiological investigations as appropriate:

    CT Scan Brain +/- MRI brain and spine if acute neurologic symptoms. NB STIR sequences on MRI to detect cervical ligamentous injury

    Non-urgent MRI Brain and whole spine if no symptoms

    Suspected (or possible) abdominal injury 

    Amylase, lipase, LFTs, Urine dipstick, FBE, Fg

    Radiological investigations as indicated

    Abdominal CT Scan should be obtained if:

    Possible paralytic ileus (absent/hypoactive bowel sounds)

    Possible intra-abdominal haemorrhage

    Significantly abnormal laboratory result (for example ALT or AST >80IU/L)

    ≥2 abnormal laboratory results

    Concerning physical examination findings (including abdominal bruising, distension or tenderness)

    * In all cases of suspected physical abuse, consideration should be given to searching for associated injuries, including screening for occult fractures as well as abdominal injuries and/or brain and spine injuries (see detailed guidelines for additional information).