Rapid, Routine Emergency Department Screening for Child Physical Abuse - A Validation Tool for Use in MHS/DHA Emergency Departments
Abstract
Study Hypothesis: Routine emergency department (ED) screening for child physical abuse has been widely implemented to improve recognition, but prior studies have been unable to identify subsequent abuse beyond a single hospital system. By linking statewide protective services data, we tested the hypothesis that routine ED screening decreases subsequent physical abuse. Methods: This was a retrospective cohort study. Data was collected for children less than 6 years old with an ED encounter in two large healthcare systems, only one of which implemented routine ED screening. The main outcome was a protective services referral 3-180 days after the ED encounter for physical abuse. Outcomes were compared for two-year periods before and after screening was implemented. Screening was conducted by the child's primary nurse and included two multi-part questions regarding signs of physical abuse. We used generalized estimating equations, adjusting for sex, age, race/ethnicity, payor and prior ED visits. Results: During the study period, there were 331,931 eligible ED encounters, with 30 percent in screening EDs, and 51 percent in the screening period. In screening EDs, screening was completed in 82 percent of eligible encounters, and was positive in 0.43 percent. 6586 (2.0 percent) encounters had a subsequent protective services referral, including 503 with moderate or severe abuse. Rates of subsequent abuse decreased during the screening period only for non-screening EDs (aOR 0.88; 95 percent CI 0.82-0.9), and this decrease was significantly different than screening EDs (aOR 0.90; 95 percent CI 0.81-1.00).Conclusion: Our program of routine ED screening was not associated with a significant decrease in subsequent physical abuse.
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 11, 2023
- Accession Number
- AD1230636
Entities
People
- Colin Henson
- Daniel M. Lindberg
- David Listman
- Jacob Rademacher
- Pang C. Chen
- Patrick Ng
- Rebecca Orsi
- Ryan A Peterson
- Toan C. Ong
Organizations
- Anschutz Medical Campus