**5. Case study**

A 4 11/12 year old male was evaluated on 2/18/2011 via telemedicine for concerns of physical abuse due to multiple bruises. This was the fourth time in 17 months that Child Protective Services (CPS) referred him for concerns of physical abuse. There were multiple prior reports for this family including verified reports for family violence and physical injury. The child resided with his mother, four half-siblings and his stepfather. His mother reported that his older sibling (age 10) caused the injuries. The child did not disclose the true etiology of his injuries until this visit when he reported that he was punched, kicked, beaten, and dragged by his mother's paramour and hit by his mother. Physical examination revealed over 40 bruises on multiple body planes. According to a systematic review of bruising in childhood, bruises concerning for physical abuse include those located away from bony prominences, are located on the face, back, buttocks and abdomen, and are multiple occurring in clusters [6]. Please note the following images were taken using the previous Tandberg Intern. UFCPT began using the Polycom Practitioner Cart August 2012 and images for a case study were not yet available. There is much improved quality of the still images captured using the new equipment

After a thorough law enforcement investigation, his sibling disclosed that he and this child were instructed by their mother to lie and state that the injuries resulted from fights between them. Additionally,itwasrevealedthatthischildwasspecificallytargetedbyhismother.Shebeathim, burned him with cigarette lighters, cut his hands, locked him outside their home in the cold and rain, and forced him to remain in a dark closet for hours. In June 2012, his mother pled guilty to 9 felonies, including six counts of child abuse. She was sentenced to 20 years. His stepfather pled guilty to 4 felonies, including one count of child abuse. He was sentenced to 5 years.

Prior to the criminal case, a Dependency Trial successfully terminated the mother and stepfa‐ ther's parental rights to each of their children. The telemedicine images were accepted into evidence and were an invaluable component of the child abuse medical professional's expert testimony.

**Figure 6.** Multiple bruises and abrasions are noted on the forehead, eye, cheek, chin and neck

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**Figure 7.** Multiple bruises and abrasions are noted on the forehead, eye, cheek, chin and neck

**Figure 4.** Multiple bruises and abrasions are noted on the forehead, eye, cheek, chin and neck

**Figure 5.** Multiple bruises and abrasions are noted on the forehead, eye, cheek, chin and neck

**Figure 6.** Multiple bruises and abrasions are noted on the forehead, eye, cheek, chin and neck

**Figure 4.** Multiple bruises and abrasions are noted on the forehead, eye, cheek, chin and neck

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**Figure 5.** Multiple bruises and abrasions are noted on the forehead, eye, cheek, chin and neck

**Figure 7.** Multiple bruises and abrasions are noted on the forehead, eye, cheek, chin and neck

**Figure 8.** Large lower abdominal bruises are evident. An abdominal CT obtained 4 days later was reported as normal.

**Figure 10.** Extensive bruising is noted on his back.

**Figure 11.** The child did not have any bruises on his anterior legs, the typical location for bruising in an active child his age.

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**Figure 9.** Extensive bruising is noted on his back.

**Figure 10.** Extensive bruising is noted on his back.

**Figure 8.** Large lower abdominal bruises are evident. An abdominal CT obtained 4 days later was reported as normal.

**Figure 9.** Extensive bruising is noted on his back.

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**Figure 11.** The child did not have any bruises on his anterior legs, the typical location for bruising in an active child his age.

**Figure 14.** Three months prior, he was evaluated for large back and flank bruising. There is a large patterned bruise along his spine which appears to have been inflicted from a punch. Once again, the child disclosed that his 10 year old

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To our knowledge, no study has evaluated the child and non-offending caregivers' satisfaction with telemedicine for child abuse evaluations. However, child and parent satisfaction with telemedicineutilizedbyothermedicalsubspecialtieshasbeenpromising.Aself-reportquestion‐ naireadministeredtopatientsreceivingpsychologicalinterventionforchildhooddepressionvia telemedicine over an 8 week period revealed that the participants and their caregivers had very high satisfaction with the services received and had similar rates of attendance when compared to the control group receiving the same services face-to-face [7]. The authors also noted that due to the children's previous experiences with other forms of technology, they appeared to adapt easily to the use of the equipment used in the study [7]. Satisfaction surveys distributed to burn centerphysicians,referringMDorRNproviders,andpatients/familymemberswhereteleconsul‐ tationwasutilized,alsorevealedthatallinvolvedintheprocess,includingthepatientandfamily, felt the encounter was helpful and that they were comfortable with the technology [8]. During an initial review of Florida's program between1999 and 2000, medical personnel reported that the children had a very high comfort level with the equipment involved [9]. With the ever growing technology present in children and parent's everyday lives, it is likely that there will be both a relatively high comfort level with the equipment and high satisfaction with the overall assess‐

brother hurt him. Figure 14 represents an adult female fist.

ment conducted via telemedicine.

**6. Future**

**Figure 12.** Add caption

**Figure 13.** Add caption

**Figure 14.** Three months prior, he was evaluated for large back and flank bruising. There is a large patterned bruise along his spine which appears to have been inflicted from a punch. Once again, the child disclosed that his 10 year old brother hurt him. Figure 14 represents an adult female fist.
