Physical Abuse Series:
Sentinel Injuries

The Physical Abuse Series: Sentinel Injuries e-learning module asks you to recognize and respond to an unexpected, medically minor injury in a pre-cruising infant. Sentinel injuries are visible to caregivers and often considered “minor" because they typically heal quickly without medical care. However, these injuries often precede further injury or abuse so warrant urgent, careful evaluation.

This case-based learning module defines Sentinel Injuries while dispelling common myths and misconceptions. Guidance for screening, history, and examination, as well as advice for talking to caregivers and Child Protective Services about even the most difficult cases will help you apply this knowledge to your clinical practice. A video interview with the author will answer many of the most frequently asked questions.

Extending from Physical Abuse Series: Core Framework which outlines “when to worry," this module encourages the learner to “think common, remember rare" in carefully considering the differential diagnosis. Used together with other modules from the Physical Abuse Series, they provide a valuable resource for frontline providers and child abuse specialists alike.

The module combines narrative descriptions and case studies to promote critical thinking in clinical practice. After working through the module, the case-based approach to learning facilitates the transfer of knowledge to clinical practice and serves as an accessible reference tool in clinical settings.

Learning Objectives

Section 1: Sentinel Injuries - Marks that Matter
  • Define ‘sentinel injury’ and explain the origin of the term.
  • Explain the significance of sentinel injuries.
  • Explain why occult injuries in infants are not sentinel injuries.
  • List the ways to screen for sentinel injuries.

Section 2: Evaluation of Sentinel Injuries
  • Plan strategies to confirm the lesion is/was an injury.
  • Identify common mimics of sentinel injuries.
  • Describe appropriate injury surveillance when a sentinel injury is confirmed.

Section 3: Talking about Sentinel Injuries
  • Demonstrate a sensitive inquiry with a parent or caregiver about sentinel injuries.
  • Explain to a parent what additional testing needs to occur and what negative testing means.
  • Educate child protective services about why a sentinel injury requires immediate action.

Section 4: Difficult Cases
  • List plausible and implausible explanations.
  • Describe strategies to help resistant families or investigators.
  • Develop a plan to improve safety for indeterminate situations.

Section 5: An Interview with the Dr. Sheets
  • List types of sentinel injuries.
  • Describe situations of sentinel injuries that create reasonable suspicion of abuse.
  • Plan what to do when urgency or testing resistance arises.

Developed in partnership with:
  • Hillary Petska, MD
  • Lynn Sheets, MD
  • Nancy Kellogg, MD, Senior Medical Editor


Authors, Contributors, and Reviewers