Everyone working in Emergency Medicine is aware that many non-accidentally-caused childhood injuries (NAI) are missed and misdiagnosed in Emergency Departments despite our best efforts to improve the screening of, and responses to, injured children. We also know that the most vulnerable children, infants, are most at risk of non-accidental trauma while at the same time they are the group most at risk of slipping through our injury-detection processes. Inflicted trauma continues to cause unacceptably high rates of mortality and morbidity in young children. Sadly, ‘missed child abuse’ remains almost the same diagnostic challenge it was 20 years ago.

This presentation will critique NAI screening tools and processes, review methods commonly used to detect injury (including EMR-based triggers and alert systems), and highlight gaps in our approaches that continue to place young children at risk of systemic failures around NAI detection and response. Consideration will also be given to the possibility that workflow and workforce pressures escalate risk. An appreciation of new and increasing risks might enable the greatest risks to be mitigated.