Early Involvement of the Child Protection Team in the Care of Injured Infants in a Pediatric Emergency Department.

Abstract

Physical abuse is a significant cause of infant morbidity and mortality. Early detection in the emergency department (ED) is crucial. We describe the impact of a clinical pathway focused on early involvement of the child protection team (CPT) and social work (SW) team for infants presenting to a pediatric emergency department with an injury concerning for abuse. The pathway lists 10 injuries associated with abuse in infants and directs consultation of the CPT and SW. It was implemented at a single site on April 1, 2014. Seasonally matched data were collected 12months before and after implementation on all children < 12months of age with a qualifying injury. Demographics, CPT and SW consults, referral to Child Protective Services, diagnostic studies, and ultimate determination of abuse by the CPT were collected. Implementation of the pathway was associated with an increase in consultation of the CPT from 17% to 47% (p<0.001) and SW from 33% to 52% (p<0.001). CPT and SW consultations were obtained more frequently for those on public compared to private insurance prior to implementation but not after (CPT: odds ratio [OR] 4.32; p=0.046; 95% confidence interval [CI] 1.03-18.15; SW: OR 3.23, p=0.034; 95% CI 1.09-9.74). Diagnostic testing increased in the post-pathway period. There was no difference in the detection of abusive injury or number of missed cases. These findings suggest that this clinical pathway was successful in increasing involvement of the CPT and SW teams and reducing socioeconomic disparity in the evaluation of infants with injuries concerning for abuse.