The impact of a child abuse guideline on differences between pediatric and community emergency departments in the evaluation of injuries

Abstract

BackgroundAlthough 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. ObjectivesTo determine differences in evaluations of infants for abuse between a PED and CEDs and whether a child abuse guideline reduced these differences. Participants and settingInfants 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. MethodsWe 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. ResultsThe 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. ConclusionsImplementation of a child abuse guideline minimized differences between a PED and CEDs in the evaluation of infants with injuries concerning for abuse.