Citation

Suresh S, Heineman E, Meyer L, Richichi R, Conger S, Young S, Coombs C, Berger R. J. Pediatr. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Elsevier Publishing)

DOI

10.1016/j.jpeds.2021.11.073

PMID

34929244

Abstract

OBJECTIVES: To evaluate the impact of layering routine child abuse screening on top of a pre-existing electronic health record-embedded child abuse clinical decision support system (CA-CDSS) in a pediatric emergency department. STUDY DESIGN: The Pittsburgh Child Abuse Screening Tool (P-CAST) was performed in all children <13 years of age and in non-verbal children ≥13 years of age who presented to a pediatric tertiary care center over 6 months. The P-CAST was layered on top of a pre-existing CA-CDSS which included passive triggers, alerts and abuse-specific order sets.

RESULTS: Of the 28,797 screens performed, 1.8% were positive in children <13 years old and 1.6% were positive in non-verbal children ≥13 years old. Half of the children with a positive P-CAST also triggered the CA-CDSS; the other half triggered only because of the P-CAST. Nineteen percent of patients with a positive P-CAST were reported to child protective services. There was no relationship between race and the odds of a positive P-CAST, or race and the likelihood of a report being made to child protective services (CPS).

CONCLUSIONS: Active routine child abuse screening improves identification of suspected child maltreatment in a children's hospital above and beyond what is identified with a CA-CDSS which depends on passive triggers. The lack of a relationship between race and a positive P-CAST or a report to CPS suggest that systematic child abuse screening may mitigate well-recognized racial disparities in identifying and reporting of suspected child maltreatment.

Language: en

Keywords

child abuse screening; electronic health record