Citation

Stavas N, Paine C, Song L, Shults J, Wood J. Acad. Pediatr. 2019; ePub(ePub): ePub.

Affiliation

Division of General Pediatrics, The Children's Hospital of Philadelphia, 34(th) Street and Civic Center Boulevard, Philadelphia, PA 19104, USA; Center for Pediatric Clinical Effectiveness and PolicyLab, The Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA 19146, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34(th) Street and Civic Center Boulevard, Philadelphia, PA 19104.

Copyright

(Copyright © 2019, Academic Pediatric Association, Publisher Elsevier Publishing)

DOI

10.1016/j.acap.2019.02.012

PMID

30880065

Abstract

OBJECTIVES: 1) To examine the association between the presence of a child abuse pathway and the odds of skeletal survey performance in infants with injuries associated with high risk of abuse, 2) to determine if pathway presence decreased disparities in skeletal survey performance.

METHODS: In this retrospective study of children <1 year diagnosed with injuries associated with high risk of abuse at hospitals in the Pediatric Hospital Information System, information regarding the presence of a child abuse pathway was collected via survey. We examined whether the presence of a child abuse pathway was associated with the odds of obtaining a skeletal survey adjusting for patient level factors.

RESULTS: Among 2085 included cases 55% were male, 69% had public insurance and 64% were White. Fifty-eight percent presented to a hospital when a pathway was present. Skeletal surveys were performed in 86% of children between 0-5 months and 73% of children 6-11 months. In our regression model, adjusted for covariates (age, race, insurance, injury) the presence of a child abuse pathway in a hospital was associated with greater odds of skeletal survey performance (OR 1.46, 95% CI 1.02-2.08). Children with public insurance had greater odds of receiving a skeletal survey (OR 2.75, 95% CI 2.11-3.52) despite presence of pathway.

CONCLUSIONS: When a child abuse clinical pathway was present, children with injuries associated with a high risk of abuse had a greater odds of receiving a skeletal survey. Differences in skeletal survey performance exist between infants with public vs. private insurance regardless of a pathway.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

Abbreviations: AAP, American Academy of Pediatrics; CI, Confidence Interval; Child Abuse; Clinical Pathways; ED, Emergency Department; ICD-9-CM, Internal Classification of Diseases, Revision 9, Clinical Modification; OR, Odds Ratio; PHIS, Pediatric Hospital Information System; SS, Skeletal Survey; Skeletal Survey; TBI, Traumatic Brain Injury