The impact of a child abuse guideline on differences between pediatric and community emergency departments in the evaluation of injuries.
Child Abuse Negl
; 122: 105374, 2021 12.
Article
em En
| MEDLINE
| ID: mdl-34737120
ABSTRACT
BACKGROUND:
Although child physical abuse is missed more frequently in community (CEDs) vs. pediatric emergency departments (PEDs), little information exists describing how evaluations of high-risk injuries differ between these settings.OBJECTIVES:
To determine differences in evaluations of infants for abuse between a PED and CEDs and whether a child abuse guideline reduced these differences. PARTICIPANTS ANDSETTING:
Infants presenting to one PED (n = 162) and three CEDs (n = 159) with 3 injury categories 1) Injuries for which the American Academy of Pediatrics recommends skeletal survey (SS) testing (infants <5-months with an oral injury or bruising, <9-months with a non-skull fracture, and < 12-months with an intracranial hemorrhage); 2) an oral injury or high-risk bruising in older infants; and 3) multiple types of high-risk injuries.METHODS:
We assessed differences in SS testing and child protective services (CPS) reporting between the PED and CEDs before and after implementation of a child abuse guideline.RESULTS:
The median (IQR) age was 4 months (2-7). Before guideline implementation, infants with injuries in categories 1 and 2 had an increased odds of SS testing in the PED vs. the CEDs (Category 1 aOR 2.83, 95% CI 1.01-8.10; Category 2 aOR 10.1, CI 1.2-88.0) and CPS reporting (Category 1 aOR 7.96, CI 2.3-26.7; Category 2 aOR 12.0, CI 1.4-103.5). After guideline implementation, there were no statistically significant differences in testing and reporting for any injury category.CONCLUSIONS:
Implementation of a child abuse guideline minimized differences between a PED and CEDs in the evaluation of infants with injuries concerning for abuse.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pediatria
/
Maus-Tratos Infantis
Tipo de estudo:
Diagnostic_studies
/
Evaluation_studies
/
Guideline
/
Observational_studies
/
Qualitative_research
/
Risk_factors_studies
Limite:
Aged
/
Child
/
Humans
/
Infant
Idioma:
En
Revista:
Child Abuse Negl
Ano de publicação:
2021
Tipo de documento:
Article