Effect of Routine Child Physical Abuse Screening Tool on Emergency Department Efficiency.
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
19 Apr 2024
19 Apr 2024
Historique:
medline:
7
5
2024
pubmed:
7
5
2024
entrez:
7
5
2024
Statut:
aheadofprint
Résumé
Physical abuse is a significant cause of morbidity and mortality for children. Routine screening by emergency nurses has been proposed to improve recognition, but the effect on emergency department (ED) workflow has not yet been assessed. We sought to evaluate the feasibility of routine screening and its effect on length of stay in a network of general EDs. A 2-question child physical abuse screening tool was deployed for children <6 years old who presented for care in a system of 27 general EDs. Data were compared for the 6 months before and after screening was deployed (4/1/2019-10/2/2019 vs 10/3/2019-3/31/2020). The main outcome was ED length of stay in minutes. There were 14,133 eligible visits in the prescreening period and 16,993 in the screening period. Screening was completed for 13,404 visits (78.9%), with 116 (0.7%) screening positive. The mean ED length of stay was not significantly different in the prescreening (95.9 minutes) and screening periods (95.2 minutes; difference, 0.7 minutes; 95% CI, -1.5, 2.8). Among those who screened positive, 29% were reported to child protective services. On multivariable analysis, implementation of the screening tool did not impact overall ED length of stay. There were no significant differences in resource utilization between the prescreening and screening periods. Routine screening identifies children at high risk of physical abuse without increasing ED length of stay or resource utilization. Next steps will include determining rates of subsequent serious physical abuse in children with or without routine screening.
Identifiants
pubmed: 38713842
doi: 10.1097/PEC.0000000000003205
pii: 00006565-990000000-00441
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: S.L.M. has equity (stock and stock options), provide consulting, is the chief medical officer, has intellectual property, and has royalties for/from Flashback Technologies, Inc, and receives grant funding from the National Institutes of Health and Department of Defense; S.L.M. has equity, is a member of the board of directors, has intellectual property, and has royalties from EZaLife, LLC. D.M.L. receives grants from the National Institutes of Health, MindSource, and Colorado Department of Public Safety; D.M.L. has an expert witness testimony in cases with concern for child abuse. The other authors declare no conflict of interest.
Références
U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. Child Maltreatment 2020. Published online 2022. Available at: https://www.acf.hhs.gov/sites/default/files/documents/cb/cm2020.pdf.
Jenny C, Hymel KP, Ritzen A, et al. Analysis of missed cases of abusive head trauma. JAMA. 1999;281:621–626.
Letson MM, Cooper JN, Deans KJ, et al. Prior opportunities to identify abuse in children with abusive head trauma. Child Abuse Negl. 2016;60:36–45.
Thackeray JD. Frena tears and abusive head injury: a cautionary tale. Pediatr Emerg Care. 2007;23:735–737.
Deans KJ, Thackeray J, Askegard-Giesmann JR, et al. Mortality increases with recurrent episodes of nonaccidental trauma in children. J Trauma Acute Care Surg. 2013;75:161–165.
Ravichandiran N, Schuh S, Bejuk M, et al. Delayed identification of pediatric abuse-related fractures. Pediatrics. 2010;125:60–66.
Oral R, Yagmur F, Nashelsky M, et al. Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse. Pediatr Emerg Care. 2008;24:816–821.
Fang X, Brown DS, Florence CS, et al. The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse Negl. 2012;36:156–165.
Peterson C, Florence C, Klevens J. The economic burden of child maltreatment in the United States, 2015. Child Abuse Negl. 2018;86:178–183.
Louwers EC, Korfage IJ, Affourtit MJ, et al. Accuracy of a screening instrument to identify potential child abuse in emergency departments. Child Abuse Negl. 2014;38:1275–1281.
Rumball-Smith J, Fromkin J, Rosenthal B, et al. Implementation of routine electronic health record-based child abuse screening in general emergency departments. Child Abuse Negl. 2018;85:58–67. doi:10.1016/j.chiabu.2018.08.008.
doi: 10.1016/j.chiabu.2018.08.008
Paek SH, Jung JH, Kwak YH, et al. Development of screening tool for child abuse in the Korean emergency department: using modified Delphi study. Medicine. 2018;97:e13724.
Louwers EC, Korfage IJ, Affourtit MJ, et al. Effects of systematic screening and detection of child abuse in emergency departments. Pediatrics. 2012;130:457–464.
Escobar MA Jr., Wallenstein KG, Christison-Lagay ER, et al. Child abuse and the pediatric surgeon: a position statement from the trauma committee, the Board of Governors and the membership of the American Pediatric Surgical Association. J Pediatr Surg. 2019;54:1277–1285.
Suresh S, Barata I, Feldstein D, et al. Clinical decision support for child abuse: recommendations from a consensus conference. J Pediatr. 2023;252:213–218.e5.
Tiyyagura G, Asnes AG, Leventhal JM. Improving child abuse recognition and management: moving forward with clinical decision support. J Pediatr. 2023;252:11–13. doi:10.1016/j.jpeds.2022.08.020.
doi: 10.1016/j.jpeds.2022.08.020
Louwers EC, Korfage IJ, Affourtit MJ, et al. Facilitators and barriers to screening for child abuse in the emergency department. BMC Pediatr. 2012;12:167.
Pierce MC, Kaczor K, Lorenz DJ, et al. Validation of a clinical decision rule to predict abuse in young children based on bruising characteristics. JAMA Netw Open. 2021;4:e215832. doi:10.1001/jamanetworkopen.2021.5832.
doi: 10.1001/jamanetworkopen.2021.5832
Christian CW; Committee on Child Abuse and Neglect. The evaluation of suspected child physical abuse. Pediatrics. 2015. doi:10.1542/peds.2015-0356.
doi: 10.1542/peds.2015-0356
Berger RP, Fromkin J, Herman B, et al. Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma. Pediatrics. 2016;138:e20153756.
Lindberg DM, Beaty B, Juarez-Colunga E, et al. Testing for abuse in children with sentinel injuries. Pediatrics. 2015;136:831–838.
Wood JN, Henry MK, Berger RP, et al. Use and utility of skeletal surveys to evaluate for occult fractures in young injured children. Acad Pediatr. 2019;19:428–437.
Lindberg DM, Berger RP, Reynolds MS, et al; Examining Siblings to Recognize Abuse Investigators. Yield of skeletal survey by age in children referred to abuse specialists. J Pediatr. 2014;164:1268–73.e1.
Worlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study. Br Med J (Clin Res Ed). 1986;293:100–102.
Ruest S, Kanaan G, Moore JL, et al. The prevalence of rib fractures incidentally identified by chest radiograph among infants and toddlers. J Pediatr. 2019;204:208–213.
Brennan B, Henry MK, Altaffer A, et al. Prevalence of abuse and additional injury in young children with rib fractures as their presenting injury. Pediatr Emerg Care. 2021;37:e1451–e1456.
Rubin DM, Christian CW, Bilaniuk LT, et al. Occult head injury in high-risk abused children. Pediatrics. 2003;111:1382–1386.
Feldman KW, Lindberg DM; ExSTRA investigators. Clinically occult abusive head trauma: which age group should we screen? Pediatr Radiol. 2019;49:1378–1379.
Boehnke M, Mirsky D, Stence N, et al; ExSTRA Investigators. Occult head injury is common in children with concern for physical abuse. Pediatr Radiol. 2018;48:1123–1129.
Trokel M, Waddimba A, Griffith J, et al. Variation in the diagnosis of child abuse in severely injured infants. Pediatrics. 2006;117:722–728.