DETAILED DIRECTED HX FOR PED INJRY CONSIDERING NAI

TABLE 32-2 A Framework to Obtain a Detailed and Directed History

Trauma Chief Complaint with Concern of Injury	Abnormal Sign or Symptom Chief Complaint with Absence of Trauma
Prior to Injury Event	Prior to Noticing Abnormality
What was the initial position of the child?	What was the child doing?
Was the child in motion (e.g., running, walking)?	Was anyone else around the child?
	When was the last time the child was free of the abnormality?
During the Injury Event	At the Time of Noticing Abnormality
What were the dynamics?	What is the abnormality (e.g., limp, swelling, disuse)?
What was the distance of the fall?	When did you first notice the abnormality?
Were any objects impacted (e.g., coffee table)?	What was the child doing?
What body part landed first?	Was anyone else present?
Did the child fall alone or with a person or object (e.g., car seat, walker)?
Environmental Factors	Environmental Factors
What was the landing surface type (e.g., carpet, wood)?	Where was the child when the abnormality was first noticed (e.g., crib, couch, day care)?
Was the surface wet or slippery?	What is the environment like where the child was first noticed to have the abnormality (e.g., type of crib, presence of bumper pads, rail up/down)?
For stair falls, how many steps did the child fall down? What is the surface type of the stairs and the landing?	Possible injurious surface types in the child’s vicinity (e.g., radiator, fireplace, stairs)?
After the Injury Event	After Noticing Abnormality
How much time elapsed before seeking medical attention?	How much time elapsed before seeking medical attention?
What was the final landing position of the child?	What were the actions of the child (e.g., get up, walk, remain still)?
What were the actions of the child (e.g., get up, walk, remain still)?	What were the behaviors of the child (e.g., cry, irritable, fussy, no change)?
What were the behaviors of the child (e.g., cry, irritable, fussy, no change)?	What was the behavior of the child during normal child care activities (e.g., dressing, diaper changes, strapping in car seat)?
What was the behavior of the child during normal child care activities (e.g., dressing, diaper changes, strapping in car seat)?	Was there any specific action that seemed to cause the child pain?