Standardizing the Evaluation of Nonaccidental Trauma in a Large Pediatric Emergency Department

Riney, Lauren C.; Frey, Theresa; Fain, Emily; Duma, Elena M.; Bennett, Berkeley L.; Kurowski, Eileen Murtagh

doi:10.1542/peds.2017-1994

Cited by 39 publications

(22 citation statements)

References 9 publications

(10 reference statements)

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“…She/he is required to refer the case to a Pediatrician/Gynecologist/ Psychologist for a better assessment and further investigations. Physical, radiological and laboratory tests, if required would be carried out by them to confirm the initial impression [29] . If a decision is made to refer the child, it is necessary to discuss his/her concern with the parents and seek consent.…”

Section: Refer For Assessmentmentioning

confidence: 99%

Child Abuse and Neglect: Role and Obligation of Pediatric Dentist in India

Varsha Sharma,

Brahmananda Dutta,

Mukul Sharma

et al. 2021

Indian Journal of Forensic Medicine & Toxicology

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Background: Child abuse is a form of behavior that involves treating someone (child, under the age of 18years) with cruelty or violence resulting in actual or potential harm to the child. It has no boundaries and may occur in any geography, culture, or in any socioeconomic strata. Many studies reveal that there is inadequate knowledge and awareness regarding child abuse recognition and reporting among health workers. Method:Most of the studies reported that trauma to head and facial region occurs in approximately 50% or more of physically abused children. Therefore Pediatric Dentist has major chance of witnessing the physical abuse in clinical practice. On the same time they are not the authority to make diagnosis of child abuse & neglect, rather identify and report the suspected cases, so that a process for effective protection of the victimized children can be initiated. It is the responsibility of the child protection agency/commission to confirm the crime and do the needful. Hence, the role of pediatric dentist in the identification and reporting of suspected child abuse is crucial. He is expected to practice 4R's: Recognize, Refer (if any), Record and Report Conclusion:Understanding the peculiar role of Pediatric Dentist in recognizing and reporting child abuse and neglect which ultimately contributes towards making better world for children.

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Section: Refer For Assessmentmentioning

confidence: 99%

Child Abuse and Neglect: Role and Obligation of Pediatric Dentist in India

Varsha Sharma,

Brahmananda Dutta,

Mukul Sharma

et al. 2021

Indian Journal of Forensic Medicine & Toxicology

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“…A follow-up study demonstrated that despite its accuracy (Louwers et al, 2014), the tool was only utilized half of the time, suggesting problems with adherence in a busy clinical setting. Systematic reviews also show inconsistent use and low-quality evidence for the accuracy of other screening tools (Bailhache, Leroy, Pillet, & Salmi, 2013; Riney et al, 2018). As such, developing an automated, reliable, and accurate screening system could possibly improve the detection of child maltreatment, particularly for vulnerable populations.…”

Section: Background and Significancementioning

confidence: 99%

What We Can Learn From Failure: An EHR-Based Child Protection Alert System

et al. 2019

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This study aimed to evaluate the efficacy of a newly implemented Child Protection Alert System (CPAS) that utilizes triggering diagnoses to identify children who have been confirmed/strongly suspected as maltreated. We retrospectively reviewed electronic health records (EHRs) of 666 patients evaluated by our institution’s child protection team between 2009 and 2014. We examined each EHR for the presence of a pop-up alert, a persistent text-based visual alert, and diagnoses denoting child maltreatment. Diagnostic accuracy of the CPAS for child maltreatment identification was assessed. Of 323 patients for whom child maltreatment was confirmed/strongly suspected, 21.7% (70/323) had a qualifying longitudinal diagnosis listed. The pop-up alert fired in 14% of cases (45/323) with a sensitivity and specificity of 13.9% (95% CI [10.4%, 18.2%]) and 100% (95% CI [98.9%, 100.0%]), respectively. The text-based visual alert displayed in 44 of 45 cases. The CPAS is a novel simple way to support clinical decision-making to identify and protect children at risk of (re)abuse. This study highlights multiple barriers that must be overcome to effectively design and implement a CPAS to protect at-risk children.

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“…Components of an abuse evaluation were not defined due to process variability and resource availability by center. Some require subspecialty abuse expert evaluation, others utilize a social worker for the abuse evaluation, and some have a protocolized approach to testing and reporting 12,13 . Best practice guidelines are available from the American Academy of Pediatrics and the American College of Surgeons to help develop local systematic programs, and every hospital must have a robust system in place 5,6 .…”

mentioning

confidence: 99%

“…Some require subspecialty abuse expert evaluation, others utilize a social worker for the abuse evaluation, and some have a protocolized approach to testing and reporting. 12,13 Best practice guidelines are available from the American Academy of Pediatrics and the American College of Surgeons to help develop local systematic programs, and every hospital must have a robust system in place. 5,6 This guideline was a collaborative effort between members of the guideline committees of the Pediatric Trauma Society (PTS), the Eastern Association for the Surgery of Trauma (EAST), and the Ray E. Helfer Society (Child Abuse Pediatrics).…”

mentioning

confidence: 99%

Identifying Maltreatment in Infants and Young Children Presenting With Fractures: Does Age Matter?

Mitchell

Norat

Auerbach

et al. 2020

Academic Emergency Medicine

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Objectives Child abuse is a significant cause of morbidity and mortality in preverbal children who cannot explain their injuries. Fractures are among the most common injuries associated with abuse but of themselves fractures may not be recognized as abusive until a comprehensive child abuse evaluation is completed, often prompted by other signs or subjective features. We sought to determine which children presenting with rib or long‐bone fractures should undergo a routine abuse evaluation based on age. Methods A systematic review searching Ovid, PubMed/Medline, Scopus, and CINAHL from 1980 to 2020 was performed. An evidence‐based framework was generated by a consensus panel and applied to the results of the systematic review to form recommendations. Fifteen articles were suitable for final analysis. Results Studies with comparable age ranges of subjects and sufficient evidence to meet the determination of abuse standard for pediatric patients with rib, humeral, and femoral fractures were identified. Seventy‐seven percent of children presenting with rib fractures aged less than 3 years were abused; when those involved in motor vehicle collisions were excluded, 96% were abused. Abuse was identified in 48% of children less than 18 months with humeral fractures. Among those with femoral fractures, abuse was diagnosed in 34% and 25% of children aged less than 12 and 18 months, respectively. Conclusion Among children who were not in an independently verified incident, the authors strongly recommend routine evaluation for child abuse, including specialty child abuse consultation, for: 1) children aged less than 3 years old presenting with rib fractures and 2) children aged less than 18 months presenting with humeral or femoral fractures (Level of Evidence: III Review).

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Standardizing the Evaluation of Nonaccidental Trauma in a Large Pediatric Emergency Department

Abstract: With our improvement methodology, we successfully increased guideline-adherent evaluation for patients with provider concern for NAT. Education and electronic support at the point of care were key drivers for initial implementation.

Cited by 39 publications

References 9 publications

Child Abuse and Neglect: Role and Obligation of Pediatric Dentist in India

Child Abuse and Neglect: Role and Obligation of Pediatric Dentist in India

What We Can Learn From Failure: An EHR-Based Child Protection Alert System

Identifying Maltreatment in Infants and Young Children Presenting With Fractures: Does Age Matter?

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