Routine Emergency Department Screening to Decrease Subsequent Physical Abuse - 18/06/24

Doi : 10.1016/j.annemergmed.2024.04.025

Daniel M. Lindberg, MD ^a,^b,^⁎ , Ryan A. Peterson, PhD, MS ^c, Rebecca Orsi-Hunt, PhD, MS ^b, Pang Ching Bobby Chen, BA ^g, Briana Kille, PhD ^f, Jacob G. Rademacher, BS ^a, Colin Hensen, MS ^c, David Listman, MD ^d,^f, Toan C. Ong, PhD ^e
^a Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
^b The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado Anschutz Medical Campus, Aurora, CO
^c Department of Biostatistics & Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO
^d Department of Pediatrics - Division of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
^e Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO
^f Analytics Resource Center, Children’s Hospital of Colorado, Aurora, CO
^g Office of Innovation, Alignment and Accountability, Washington State Department of Children, Youth and Families, Olympia, WA

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 18 June 2024

Abstract

Study objective

Emergency department (ED) screening for child physical abuse has been widely implemented, with uncertain effects on child abuse identification. Our goal was to determine the effect of screening on referrals to child protective services (CPS) identifying abuse.

Methods

We performed a retrospective cohort study of children younger than 6 years old with an ED encounter at 1 of 2 large health care systems, one of which implemented routine child abuse screening. The main outcome was initial (<2 days) or subsequent (3 to 180 days) referral to CPS identifying child abuse using linked records. We compared outcomes for the 2-year period after screening was implemented to the preperiod and nonscreening EDs using generalized estimating equations to adjust for sex, age, race/ethnicity, payor and prior ED encounters and clustered by center.

Results

Of the 331,120 ED encounters, 41,589 (12.6%) occurred at screening EDs during the screening period. Screening was completed in 34,272 (82%) and was positive in 188 (0.45%). Overall, 7,623 encounters (2.3%) had a subsequent referral, of which 589 (0.2%) identified moderate or severe abuse. ED screening did not change initial (adjusted odds ratio [aOR]=1.01, 95% confidence interval [CI] 0.89 to 1.15) or subsequent referral to CPS when compared to the prescreening period (aOR=1.05, 95% CI 0.9 to 1.18) or to the nonscreening EDs (aOR=1.06, 95% CI 0.92 to 1.21).

Conclusion

Routine screening did not affect initial or subsequent referrals to CPS.

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Plan

Introduction

Methods

Participants and Settings

Routine Screening Program

Outcomes and Data Abstraction

	Please see page XX for the Editor’s Capsule Summary of this article.
	Supervising editor: Lise E. Nigrovic, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: DML and RO-H conceived and designed the study and obtained research funding. RAP and CH conducted the statistical analysis. TO conducted data linkage between health care and social services data. RO-H, PCBC, and BK coordinated data collection, sharing, and quality assurance. JR performed data abstraction and project coordination, and managed the data, including quality control. DL provided critical review of the study protocol. DML drafted the manuscript. All authors contributed substantially to the revision of the manuscript. DML takes responsibility for the paper as a whole.
	Data sharing statement: We are unable to share data for the main outcome of subsequent abuse due to limitations of our data sharing agreement with Colorado’s Department of Human Services. Given the extraordinarily sensitive nature of determinations of child abuse, the Department required deletion of data from a secure server after the completion of data analyses.
	Authorship: All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This project was supported by a Restoral award from the 59th Air Wing. The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its components. The funders had no role in the data analysis or the decision to submit for publication. Dr. Lindberg reports activity as a paid expert witness in cases with concern for child abuse. The other authors affirm that they have no conflicts of interest.
	Presentation information: Initial results were presented at the Annual Meeting of the Helfer Society, April 2023.