LCAST vs Chicago Medic Guide

The Lurie Children’s Child Injury Plausibility Assessment Support Tool (LCAST) is an app based on a validated Bruising Clinical Decision Rule (BCDR) called the TEN-4-FACESp. Use of this tool has the potential to improve recognition of abuse in young children with bruising. This app functions only as a screening tool and cannot be used to diagnose abuse. The app applies to children less than 4.0 years of age with bruising. If the child is older than 4.0 and/or bruising is not present, this tool cannot be used. In those circumstances, alternative methods of screening for abuse are needed. WHY FOCUS ON BRUISING? Bruising is the most common injury resulting from physical abuse and is the most overlooked or misdiagnosed antecedent injury prior to an abuse-related fatality or near-fatality in a young child. Bruising occurs from both accidental and abusive trauma, but differences identified by the TEN-4-FACESp bruising clinical decision rule may allow improved and earlier recognition of the abused child. ABOUT THE APP: The app is intended for clinical use by licensed healthcare professionals and providers. The app can inform decision-making and be used as an educational tool for learning about bruising characteristics that commonly result from abusive and accidental injury. The core feature of the app is an interactive 3D body model that allows the user to utilize visual cues of the human body to input clinical observations. The result is the opportunity to compare a child’s bruise findings to the published evidence resulting from a NIH-funded multi-center study. The data that drive the app are based on 2,161 patients of which 410 (19%) were classified by a multi-disciplinary panel of medical experts as abuse and 1,713 (79%) as accident. The TEN-4-FACESp bruising clinical decision rule resulted from analysis of 35 body regions and is 96% specific and 87% sensitive for distinguishing bruising from abuse versus accident. The TEN-4-FACESp has three components based on: 1) specific body regions with bruising, 2) patterned bruising, and 3) bruising anywhere on non-mobile infants. An affirmative finding for any one of the three TEN-4-FACESp components without a clear and reasonable explanation indicates a potential risk for abuse. The child may warrant further evaluation and consultation with an expert in child abuse should be considered. In addition to using the data in this app, the user should always check with a doctor before making any medical decisions.

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