Resident Physician St. Christopher's Hospital for Children Saint Christopher's Hospital for Children Philadelphia, Pennsylvania, United States
Background: Child abuse is a leading cause of mortality in children. Medical professionals may miss up to 75% of abuse cases due to failure in identifying signs of abuse. A systematic review in 2008 by Louwers found that the implementation of an intervention led to an increase in number of suspected cases of child abuse. The aim of this study was to determine the effectiveness of a screening tool in identifying non-accidental trauma.
Objective: The purpose of this study was to determine if the SCHC screening tool implemented during ED triage leads to an increase in cases of NAT being formally identified for evaluation in children less than 2 years old.
Design/Methods: A retrospective chart review was conducted for all patients from the Pennsylvania Trauma Outcomes Study (PTOS) hospital database between ages 0 and 2 years old who presented to SCHC ED from 11/2015 to 11/2017 (pre-screening tool) and then from 12/2017 to 11/2019 (post-screening tool). Other data analyzed included ED length of stay and child protection services reporting. Chi-square analysis was used to compare data between the two groups.
Results: Of the 442 patients, there were 158 pre- and 284 post-screening tool. Only 34 (24.6%) pre-screening tool had a positive screen during ED triage, while post-screening tool, 211 (80%) had positive screenings ((1, 403) = 115.11, p < .001). No significant difference between the two groups with official diagnoses of abuse, however the number of patients without a child protection team note significantly decreased from 40.3% before to 21.9% after ((6, 422) = 20.92, p < .002). No significant difference was found in length of stay in the ED between the two groups, however, patients spent more time in the hospital before the screening tool (3.56, SD = 9.23) compared to after (2.30, SD = 3.51): t(440) = 9.06, p = .003). More reports were made to child protective services after (96.8%) compared to before (67.7%) ((1,439) = 72.94, p < .001). Conclusion(s): Implementation of a screening tool for NAT led to more positive screenings concerning for abuse during ED triage, more evaluations by a child protection team and more reports to child protective services. There was no difference in official diagnoses of abuse or ED length of stay between the two groups but overall hospital length of stay was longer in the pre-screening tool group.
Authors/Institutions: Megan Anton, Saint Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States; Michele Bresler, Saint Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States; Norrell Atkinson, Saint Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States; Ross Budziszewski, Saint Christopher's Hospital for Children, Philadelphia, Pennsylvania, United States; Tess Munoz, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States; Alexander R. Eaton, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States