Injuries with one or more of the following characteristics may be inflicted, rather than accidental. If you are investigating an injury to a consumer that has one or more of these characteristics, you should at least consider the possibility that the person was abused as you conduct the investigation. The injury itself is not proof of abuse. Conduct a careful investigation and base your conclusion on all of the evidence.

The Difference:

Accidental: This happens casually and by chance.
Inflicted: This is caused by a conscious act of another person.

Indications of Inflicted Injury: General

• Injuries that are unexplained or are inconsistent with the caretaker's explanation.
• Bilateral injuries. Accidents usually cause injuries on only one side.
• Clustered injuries (group of injuries in the same area).
• Patterned injuries, such as the outline of a belt.
• Grab marks on the upper extremities.
• Human bites.
• Injuries that are consistently noticed after consumer's absence from the residence (i.e., after a weekend home visit).
• Internal injuries, such as bleeding or liver damage.
• Delay in seeking medical attention.

Indications of Inflicted injury: Fractures

• More than one fracture in various stages of healing.
• Multiple or repeated fractures to the same bone or the same area.
• Injury is "accidentally" discovered during an exam.
• Posterior (back) rib fractures are most likely due to inflicted injury.

Indications of Inflicted injury: Burns

• Delay in obtaining treatment.
• Cigar or cigarette burns.
• Immersion burns (i.e., sock-like and/or glove like).
• Burn patterns correspond to heated objects, such as a cigarette or iron.
• The burn is sharply outlined.

Indications of Inflicted injury: Bruises

• Bruised in areas not usually visible.
• Black eyes that are bilateral or with no injury to the nose.
• Patterned bruises.
• Multiple bruises in various stages of healing.
  

  REMEMBER, CONCLUSIONS MUST BE BASED ON EVIDENCE