Potential Opportunities for Prevention or Earlier Diagnosis of Child Physical Abuse in the Inpatient Setting

Puls, Henry T.; Anderst, James D.; Bettenhausen, Jessica L.; Masonbrink, Abbey; Markham, Jessica L.; Plencner, Laura; Krager, Molly; Johnson, Matthew; Walker, Jacqueline M.; Greeley, Christopher S.; Hall, Matthew

doi:10.1542/hpeds.2017-0109

Cited by 15 publications

(13 citation statements)

References 42 publications

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“…Hospitalizations qualified as being abuse related if they met any of the following criteria: (1) ICD-9-CM codes for an injury and abuse, (2) ICD-9-CM codes for an injury and assault, (3) ICD-9-CM codes for retinal hemorrhages or anoxic brain injury and abuse, or (4) any ICD-9-CM code for abusive head trauma (Supplemental Table 4). 3,[28][29][30]…”

Section: Outcome Measurementioning

confidence: 99%

“…However, the first 6 months of an infant's life is a period with high rates of abuse and abuse-related fatality. 3,30 Second, the NRDs did not allow for an assessment of individual, family, and community psychosocial contributors to abuse risk, such as maternal educational attainment, marital status, or caregiver mental illness. 48 Third, we could not control for social and preventive interventions that some newborns would have almost certainly received.…”

Section: Figurementioning

confidence: 99%

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Newborn Risk Factors for Subsequent Physical Abuse Hospitalizations

Puls¹,

Anderst

Bettenhausen³

et al. 2019

Pediatrics

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OBJECTIVES:To describe the prevalence of risk factors for abuse and newborns' risks for physical abuse hospitalizations during early infancy. METHODS:We created a nationally representative US birth cohort using the 2013 and 2014 Nationwide Readmissions Databases. Newborns were characterized by demographics, prematurity or low birth weight (LBW), intrauterine drug exposure, and medical complexity (including birth defects). Newborns were tracked for 6 months from their birth hospitalization, and subsequent abuse hospitalizations were identified by using International Classification of Diseases, Ninth Revision codes. We calculated adjusted relative risks (aRRs) with multiple logistic regression, and we used classification and regression trees to identify newborns with the greatest risk for abuse on the basis of combinations of multiple risk factors.RESULTS: There were 3 740 582 newborns in the cohort. Among them, 1247 (0.03%) were subsequently hospitalized for abuse within 6 months. Among infants who were abused, 20.4% were premature or LBW, and 4.1% were drug exposed. Premature or LBW newborns (aRR 2.16 [95% confidence interval (CI): 1.87-2.49]) and newborns who were drug exposed (aRR 2.86 [95% CI: 2.15-3.80]) were independently at an increased risk for an abuse hospitalization, but newborns with medical complexity or noncardiac birth defects were not. Publicly insured preterm or LBW newborns from rural counties had the greatest risk for abuse hospitalizations (aRR 9.54 [95% CI: 6.88-13.23]). Publicly insured newborns who were also preterm, LBW, or drug exposed constituted 5.2% of all newborns, yet they constituted 18.5% of all infants who were abused.CONCLUSIONS: Preterm or LBW newborns and newborns who were drug exposed, particularly those with public insurance and residing in rural counties, were at the highest risk for abuse hospitalizations. Effective prevention directed at these highest-risk newborns may prevent a disproportionate amount of abuse.WHAT'S KNOWN ON THIS SUBJECT: Current physical abuse prevention strategies have had inconsistent and marginal effectiveness. A better stratification of newborn infants' risk for physical abuse may prove valuable in informing the allocation of preventive services and improving their effectiveness.WHAT THIS STUDY ADDS: Using a nationally representative birth cohort, we report on risk factors for physical abuse that can be readily ascertained at birth. Five percent of newborns were identified as accounting for 1 in 5 infants who are abused and should be targets for secondary prevention.

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Section: Outcome Measurementioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Newborn Risk Factors for Subsequent Physical Abuse Hospitalizations

Puls¹,

Anderst

Bettenhausen³

et al. 2019

Pediatrics

Self Cite

View full text Add to dashboard Cite

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“…However, research demonstrates that instances of abuse and neglect are often not identified by pediatricians ( Hymel et al, 2018 ; Jenny et al, 1999 ; Lane et al, 2002 ). Notably, prior work suggests that certain injuries are more common among children who are eventually diagnosed with maltreatment ( Lindberg et al, 2015 ; Puls et al, 2018 ; Sheets et al, 2013 ; Thackeray et al, 2016 ). Specifically, one study examined infants less than 12 months of age with definite abuse and found that more than one-fourth (28%) had a previous injury suggestive of maltreatment (i.e., a sentinel injury).…”

Section: Introductionmentioning

confidence: 99%

“… Thackeray et al (2016) determined that children less than 12 months of age with an abuse diagnosis or a skeletal survey, which often indicates provider concern for abuse, contusions (28%), fractures (27%), open wounds (17%), and superficial injuries (12%) were relatively common. In a study of inpatient pediatric hospitalizations, children who were diagnosed with physical abuse were more likely to have previous diagnoses of fractures, head injuries, and symptoms concerning for abusive head trauma than children with unintentional injuries ( Puls et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…This is important as neglect may result in injuries due to improper supervision or unsafe environments ( Damashek et al, 2014 ; Notrica et al, 2020) and is more common than physical abuse ( US Department of Health and Human Services, 2020 ). Further, two of the studies only utilized data regarding pediatric hospital encounters (i.e., inpatient, emergency department, ambulatory surgery, and observation data) to identify cases of both abuse and minor injuries ( Lindberg et al, 2015 ; Puls et al, 2018 ), thereby missing both abuse and injury diagnoses made in outpatient settings, which may be both more common and less severe than those diagnosed in an inpatient setting. An additional study only included children who were diagnosed with abuse by an inpatient hospital-based Child Protection Team but reviewed all available medical records to identify previous injuries ( Sheets et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Injuries Among Medicaid Enrolled Infants Prior to Child Abuse and Neglect

2021

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Prior research has identified common injuries among children who experience child maltreatment; however, most of this work has focused on inpatient settings and has excluded many cases of neglect. This study examines the prevalence of injuries that occur prior to a diagnosis of child maltreatment, as well as the proportion of children with well-child visits prior to the injury and child maltreatment diagnosis. Based on a secondary analysis of Medicaid data from four states, we found that among infants with 12 months of continuous enrollment ( N = 4817), 30.6% of those diagnosed with maltreatment were previously diagnosed with an injury. Among infants diagnosed with child maltreatment, 88.4% had at least one well-child visit prior to the maltreatment diagnosis. Among children with a maltreatment diagnosis and a prior injury, 84% had at least one well-child visit preceding the injury. These results indicate that most children had at least one well-child visit prior to being diagnosed with child maltreatment or an injury, indicating opportunities for prevention.

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Current Issues in Physical Abuse

Palusci

2022

Handbook of Child Maltreatment

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Potential Opportunities for Prevention or Earlier Diagnosis of Child Physical Abuse in the Inpatient Setting

Cited by 15 publications

References 42 publications

Newborn Risk Factors for Subsequent Physical Abuse Hospitalizations

Newborn Risk Factors for Subsequent Physical Abuse Hospitalizations

Prevalence of Injuries Among Medicaid Enrolled Infants Prior to Child Abuse and Neglect

Current Issues in Physical Abuse

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