Association between emergency department utilization and the risk of child maltreatment in young children

Xiaoxin Kuang,Guohua Li,Yumiko Aratani

doi:10.1186/s40621-018-0176-5

Xiaoxin Kuang, Guohua Li + Show 1 more

Open Access

https://doi.org/10.1186/s40621-018-0176-5

Copy DOI

Journal: Injury Epidemiology	Publication Date: Dec 1, 2018
Citations: 9	License type: open-access

Affiliation: Columbia University

Abstract

BackgroundThis study aims to assess the association between emergency department (ED) utilization and the risk of child maltreatment.MethodsUsing ED discharge data from the California’s Office of Statewide Health Planning (OSHPD) and Development for 2008–2013, we performed a nested case-control study to examine the relationship between the frequency of ED visits and child maltreatment diagnosis under 4 years of age among children born in California between 2008 and 2009 who visited the ED.ResultsThe study sample consisted of 3772 children diagnosed with child maltreatment (cases) and 7544 children selected by incidence density sampling (controls). After adjustment for demographic characteristics, the estimated odds ratios of child maltreatment were 1.72 (95% CI:1.55–1.90) for those with two to three ED visits and 3.03 (95% CI: 2.69–3.41) for those with four or more ED visits, compared to children with one visit. Race/ethnicity, insurance status, and location of residence were also significantly associated with the risk of child maltreatment.ConclusionsYoung children with higher frequency of ED visits are at significantly increased risk of being victims of child maltreatment. ED utilization patterns and other established risk markers may assist healthcare professionals in identifying and treating victims of child maltreatment.

Highlights

Child maltreatment, which is defined as child abuse or neglect by the World Health Organization (2016), is an important public health issue in the United States
Emergency care may be especially important for infants and young children who are victims of maltreatment as they are more vulnerable for traumatic injuries and may require immediate medical treatment (Overpeck et al 1998; Wu et al 2015)
These findings suggest that the emergency department (ED) setting may offer a crucial opportunity for both earlier identification and prevention for child maltreatment

Summary

Introduction

Child maltreatment, which is defined as child abuse or neglect by the World Health Organization (2016), is an important public health issue in the United States. In 2015, state agencies found an estimated 683,000 victims of child maltreatment, and approximately 1670 children died as a result of abuse and neglect (U.S Department of Health and Human Services 2017). Due to the complexity of identifying child maltreatment in the clinical setting, children who arrive at the ED with severe injuries and diagnosis of physical abuse may have previously presented with less severe injuries and overlooked detection of maltreatment (Hornor 2005; Wu et al 2015) These findings suggest that the ED setting may offer a crucial opportunity for both earlier identification and prevention for child maltreatment.

Objectives

Methods

Results

Conclusion