TEN-4-FACESp

This is a revised screening tool validated in a study that involved the original author, making it a non-independent validation. The study also states: “To optimize the sensitivity of the refined rule, we defined the cost of a false-negative prediction as 20:1 relative to a false-positive prediction.” In practice, this implies that the harm of falsely accusing someone of child abuse is treated as twenty times less significant than failing to identify true abuse. This approach fuels the concern that Child Abuse Pediatricians (CAPs) systematically overdiagnose abuse. By undervaluing the harm of false accusations, it discourages thorough investigation of plausible explanations and limits consideration of alternative differential diagnoses.

Note the yellow-highlighted sections in the graphic below—these are often overlooked.

Many hospitals, medical networks, and, most concerningly, Child Abuse Pediatricians (who should know better) ignore the crucial caveat about requiring a finding of “without a reasonable explanation.” Instead, they jump to a diagnosis after a well-meaning ER doctor or family pediatrician—simply following network directives—refers an innocent family for a “child abuse workup.” In too many cases, that “workup” amounts to little more than a Child Abuse Pediatrician refusing to consider reasonable explanations or failing to provide differential diagnosis, or any justification for deeming those explanations implausible. Some of these unethical CAPs even dismiss their responsibility outright, claiming “that’s not my job,” “I don’t investigate,” or vaguely asserting that their conclusions are “based on the studies,” while labeling virtually anything as part of a “pattern.” This misapplication undermines the intended purpose of the TEN-4-FACESp screening tool, which was designed specifically for evaluating unexplained bruising—not to shortcut genuine diagnostic investigation.