SCAN for Abuse: Electronic Health Record-Based Universal Child Abuse Screening.

Abuse screening Child abuse Clinical decision support Electronic health record Emergency department Measurement

Journal

Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631

Informations de publication

Date de publication:
20 Oct 2023
Historique:
received: 09 10 2023
accepted: 13 10 2023
medline: 13 11 2023
pubmed: 13 11 2023
entrez: 12 11 2023
Statut: aheadofprint

Résumé

Identification of physical abuse at the point of care without a systematic approach remains inherently subjective and prone to judgement error. This study examines the implementation of an electronic health record (EHR)-based universal child injury screen (CIS) to improve detection rates of child abuse. CIS was implemented in the EHR admission documentation for all patients age 5 or younger at a single medical center, with the following questions. 1) "Is this patient an injured/trauma patient?" 2) "If this is a trauma/injured patient, where did the injury occur?" A "Yes" response to Question 1 would alert a team of child abuse pediatricians and social workers to determine if a patient required formal child abuse clinical evaluation. Patients who received positive CIS responses, formal child abuse work-up, and/or reports to Child Protective Services (CPS) were reviewed for analysis. CPS rates from historical controls (2017-2018) were compared to post-implementation rates (2019-2021). Between 2019 and 2021, 14,150 patients were screened with CIS. 286 (2.0 %) patients screened received positive CIS responses. 166 (58.0 %) of these patients with positive CIS responses would not have otherwise been identified for child abuse evaluation by their treating teams. 18 (10.8 %) of the patients identified by the CIS and not by the treating team were later reported to CPS. Facility CPS reporting rates for physical abuse were 1.2 per 1000 admitted children age 5 or younger (pre-intervention) versus 4.2 per 1000 (post-intervention). Introduction of CIS led to increased detection suspected child abuse among children age 5 or younger. Level II. Study of Diagnostic Test.

Sections du résumé

BACKGROUND BACKGROUND
Identification of physical abuse at the point of care without a systematic approach remains inherently subjective and prone to judgement error. This study examines the implementation of an electronic health record (EHR)-based universal child injury screen (CIS) to improve detection rates of child abuse.
METHODS METHODS
CIS was implemented in the EHR admission documentation for all patients age 5 or younger at a single medical center, with the following questions. 1) "Is this patient an injured/trauma patient?" 2) "If this is a trauma/injured patient, where did the injury occur?" A "Yes" response to Question 1 would alert a team of child abuse pediatricians and social workers to determine if a patient required formal child abuse clinical evaluation. Patients who received positive CIS responses, formal child abuse work-up, and/or reports to Child Protective Services (CPS) were reviewed for analysis. CPS rates from historical controls (2017-2018) were compared to post-implementation rates (2019-2021).
RESULTS RESULTS
Between 2019 and 2021, 14,150 patients were screened with CIS. 286 (2.0 %) patients screened received positive CIS responses. 166 (58.0 %) of these patients with positive CIS responses would not have otherwise been identified for child abuse evaluation by their treating teams. 18 (10.8 %) of the patients identified by the CIS and not by the treating team were later reported to CPS. Facility CPS reporting rates for physical abuse were 1.2 per 1000 admitted children age 5 or younger (pre-intervention) versus 4.2 per 1000 (post-intervention).
CONCLUSIONS CONCLUSIONS
Introduction of CIS led to increased detection suspected child abuse among children age 5 or younger.
LEVEL OF EVIDENCE METHODS
Level II.
TYPE OF STUDY METHODS
Study of Diagnostic Test.

Identifiants

DOI: 10.1016/j.jpedsurg.2023.10.025 PMID: 37953157
pubmed: 37953157
pii: S0022-3468(23)00635-8
doi: 10.1016/j.jpedsurg.2023.10.025
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Auteurs

Nolan R Martin (NR)

Eastern Virginia Medical School, Norfolk, VA, USA. Electronic address: martinnr@evms.edu.

Anneke L Claypool (AL)

Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.

Modupeola Diyaolu (M)

Stanford University School of Medicine, Stanford, CA, USA.

Katelyn S Chan (KS)

University of Washington School of Medicine, Seattle, WA, USA.

Elizabeth A'Neals (E)

Lucile Packard Children's Hospital, Stanford, CA, USA.

Karan Iyer (K)

Lucile Packard Children's Hospital, Stanford, CA, USA.

Christopher C Stewart (CC)

Lucile Packard Children's Hospital, Stanford, CA, USA.

Melissa Egge (M)

Lucile Packard Children's Hospital, Stanford, CA, USA.

Krysta Bernacki (K)

Lucile Packard Children's Hospital, Stanford, CA, USA.

Michelle Hallinan (M)

Lucile Packard Children's Hospital, Stanford, CA, USA.

Linda Zuo (L)

Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.

Urvi Gupta (U)

Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.

Navleen Naru (N)

Stanford University School of Medicine, Stanford, CA, USA.

David Scheinker (D)

Department of Management Science and Engineering, Stanford University, Stanford, CA, USA; Stanford University School of Medicine, Stanford, CA, USA.

Arden M Morris (AM)

Stanford University School of Medicine, Stanford, CA, USA.

Margaret L Brandeau (ML)

Department of Management Science and Engineering, Stanford University, Stanford, CA, USA.

Stephanie Chao (S)

Stanford University School of Medicine, Stanford, CA, USA.

Classifications MeSH