Prediction of Child Abuse Risk from Emergency Department Use

Abstract

Objective-To examine whether pre-abuse rates and patterns of emergency department (ED) visits between children with supported child abuse and age-matched controls are useful markers for abuse risk.Study design-A population-based case-control study using probabilistic linkage of four statewide data sets. Cases were abused children <13 years, identified between 1/1/01-12/31/02. For each case, a birth date matched population-based control was obtained. Outcome measures were rate ratios of ED visits in cases compared with controls.Results-9795 cases and 9795 controls met inclusion criteria. 4574 cases (47%) had an ED visit; thus linked to the ED database versus 2647 controls (27%). The crude ED visit rate per 10 000 persondays of exposure was 8.2 visits for cases compared with 3.9 visits for controls. Cases were almost twice as likely as controls (adjusted rate ratio = 1.8, 95% CI:1.5, 1.8) to have had a prior ED visit. Leading ED discharge diagnoses were similar for both groups.Conclusions-Children with supported child abuse have higher ED use prior to abuse diagnosis, when compared with the general pediatric population. However, neither the rate of ED use nor the pattern of diagnoses offers sufficient specificity to be useful markers of risk for abuse.Child abuse is the fourth leading cause of childhood death in the United States.(1) Current evidence suggests that many children who die from child abuse are seen by a health care provider for medical conditions related to abuse prior to the diagnosis, possibly resulting in a missed opportunity for intervention. (2-12) For example, King studied a cohort of fatally abused children and found that almost 20% of the children had documented contact with the health care community for reasons other than routine care within a month before death. (7) Similarly, Jenny et al found that 31% of children with abusive head trauma had been seen by a health care provider prior to recognition of their head injury, with a mean time to correct diagnosis in these children of seven days. (2) Author contact: Elisabeth Guenther, MD, MPH, Associate Professor, Division of Pediatric Emergency Medicine, University of Utah School of Medicine, PO Box 581289, Salt Lake City, Utah 84158, Phone: (801)587-6570, Fax: (801)587-6595, E-mail: elisabeth.guenther@hsc.utah.edu. Edited by TW and WFB Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. These studies suggest that the ED may be a clinical setting where there is an opportunity for earlier identification of both physical and sexual child abuse; 12 however, there is little information on whether abused c...

Variation in recording of child maltreatment in administrative records of hospital admissions for injury in England, 1997-2009

“…This problem would be avoided if health and social care data were linked to create anonymised data for analyses. Such data could provide powerful insights into the health problems faced by maltreated children seen by social care,19 20 and into the pathways from health into social care 21–23. Without follow-up data, our inferences about the sources of such variation need to be cautious as recording of maltreatment in HES reflects processes at three levels: recognition by clinicians, recording in hospital notes and the quality of information capture by hospital coders and their approach to coding.…”

Child abuse followed by fatal systemic Pseudomonas aeruginosa infection

“…Interestingly, Guenther et al stated that ''children who went onto have supported neglect or physical abuse did not have more injury visits than control subjects'' and that their study ''did not find any 'red flags' from either the frequency or pattern of a child's ED visits, which would allow early identification of children at risk for abuse by the ED physician'' [10].…”

Evaluation of Child Maltreatment in the Emergency Department Setting

“…These children have a higher use of EDs compared with the general population. 20 Although it is unreasonable to treat every patient as if they are being abused, it is the role of EPs to keep a high index of suspicion. There have been numerous attempts at developing appropriate criteria for ED screening of abuse, including reminder systems, scheduled education, and automatic screening based on risk factors.…”

“…There have been numerous attempts at developing appropriate criteria for ED screening of abuse, including reminder systems, scheduled education, and automatic screening based on risk factors. 20,21 Although observational studies suggest that these may be useful, none have been shown to be sufficiently accurate or reproducible. [22][23][24][25] A brief introspection of whether the child is being abused is often enough of a consideration, but there are several chief complaints that deserve further investigation.…”