Evaluation of an Emergency Department High-risk Bruising Screening Protocol

Crumm, Caitlin E.; Brown, Emily; Thomas-Smith, Siobhan; Yu, Daniel Ta Yo; Metz, James B; Feldman, Kenneth W.

doi:10.1542/peds.2020-002444

Cited by 18 publications

(16 citation statements)

References 34 publications

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“…Continued reliance on the growing foundation of evidence-based literature and the creation of shared clinical guidelines for assessing child abuse concerns is important. To this end, ongoing work in the conception, validation, and implementation of clinical decision rules and artificial intelligence support in electronic medical records may be an avenue to mitigate the effect of implicit biases in the assessment of child physical abuse (Crumm et al, 2021; Pierce et al, 2021; Shahi et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Child Abuse Pediatricians Assess a Low Likelihood of Abuse in Half of 2890 Physical Abuse Consults

et al. 2021

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The aim of this study was to examine the frequency with which child abuse pediatricians (CAPs) assess consultations as low versus high likelihood of abuse. In this retrospective secondary analysis of data from the Examining Siblings to Recognize Abuse (ExSTRA) study, the likelihood of abuse score for 2890 consultations at 20 medical centers was collected. Descriptive statistics were used to examine the percentage of cases representing low versus high likelihood of abuse (i.e., score of 1–4 vs. 5–7 on a 7-point scale). Linear and logistic regression analyses were used to examine score variability between medical centers. Overall, fifty-three percent of cases were assessed as low likelihood of abuse, suggesting that CAPs were equally as likely to assess a high versus low likelihood of abuse. The percentage of cases representing low likelihood of abuse differed significantly ( P < .001) between medical centers after controlling for patient age, sex, race/ethnicity, twin/triplet status, injury types, and injury severity. The variability between CAP assessments at different medical centers is discussed, along with potential contributors to this variability and directions for future work.

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Section: Discussionmentioning

confidence: 99%

Child Abuse Pediatricians Assess a Low Likelihood of Abuse in Half of 2890 Physical Abuse Consults

et al. 2021

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“…14,15 given the known relationship between bruising in young infants and missed abuse. 5,16 However, many of the callbacks involved a lack of appropriate initial testing and sexual abuse and/or neglect, and 17% were from the clinic or inpatient setting.…”

Section: Discussionmentioning

confidence: 99%

A System-Wide Hospital Child Maltreatment Patient Safety Program

et al. 2021

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BACKGROUND AND OBJECTIVES: Hospital-wide patient safety programs have been used to ensure appropriate provision of care. Similar approaches have not been widely applied to child maltreatment. In this study, we describe a hospital-system child maltreatment safety program by characterizing the frequency of patients needing further intervention, associations between the age of patient and location of care and need for further intervention, and patients who require immediate intervention.METHODS: For all staff concerns for child maltreatment, a social worker completed a patient at risk (PAR) form. All PAR forms were reviewed within 24 hours by the child abuse team and categorized on the basis of 6 types of interventions, most significantly an "immediate callback." Wilcoxon rank and x 2 tests were used for group comparisons.RESULTS: Over a 30-month period, program interventions occurred in 2061 of 7698 PARs (26.8%). The most common reason for a PAR form was physical abuse (32.5%). Subjects requiring an intervention were no different in age than those who did not (median age: 5.6 vs 5.2 years). PAR forms performed in the emergency departments or urgent care were more likely to require an intervention than inpatient (odds ratio: 4.4; 95% confidence interval 3.6-5.3) or clinic (odds ratio: 2.0; 95% confidence interval 1.7-2.3) PAR forms. Of the 53 immediate callbacks, potential diagnostic errors and safe discharge concerns occurred in nearly one-half, and >40% involved subjects with bruising. Immediate follow-up in the child abuse pediatrician clinic occurred in 87% (46 of 53) of cases, resulting in a new or changed diagnosis in 57% of such cases.

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“…A recent study showed that a significant proportion of young children with suspicious bruising was finally confirmed as victims of physical abuse. According to Crumm et al’s research [ 15 ] published in 2021, among the 43771 visitors to emergency departments who were screened for bruising, 163 (0.4%) had high-risk bruising according to the TEN4 FACESp rule. The rates of likely or definite abuse were 50% and 28% in children aged under 6 months and 6 months to 4 years, respectively.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…These findings emphasize the importance of minor wounds, such as bruising in abnormal regions of the body, for starting an investigation of possible child abuse. Moreover, in this study, the results showed that of 48 children aged 6 months or younger, 30 (63%) children underwent head computed tomography (CT) scans, and seven of these 30 (23%) children exhibited intracranial or head injury [ 15 ].…”

Section: Clinical Featuresmentioning

confidence: 99%

Diagnosis of Abusive Head Trauma : Neurosurgical Perspective

Kwak

2022

J Korean Neurosurg Soc

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Abusive head trauma (AHT) is the most severe form of physical abuse in children. Such injury involves traumatic damage to the head and/or spine of infants and young children. The term AHT was introduced to include a wider range of injury mechanisms, such as intentional direct blow, throw, and even penetrating trauma by perpetuator(s). Currently, it is recommended to replace the former term, shaken baby syndrome, which implicates shaking as the only mechanism, with AHT to include diverse clinical and radiological manifestations. The consequences of AHT cause devastating medical, social and financial burdens on families, communities, and victims. The potential harm of AHT to the developing brain and spinal cord of the victims is tremendous. Many studies have reported that the adverse effects of AHT are various and serious, such as blindness, mental retardation, physical limitation of daily activities and even psychological problems. Therefore, appropriate vigilance for the early recognition and diagnosis of AHT is highly recommended to stop and prevent further injuries. The aim of this review is to summarize the relevant evidence concerning the early recognition and diagnosis of AHT. To recognize this severe type of child abuse early, all health care providers maintain a high index of suspicion and vigilance. Such suspicion can be initiated with careful and thorough history taking and physical examinations. Previously developed clinical prediction rules can be helpful for decision-making regarding starting an investigation when considering meaningful findings. Even the combination of biochemical markers may be useful to predict AHT. For a more confirmative evaluation, neuroradiological imaging is required to find AHT-specific findings. Moreover, timely consultation with ophthalmologists is needed to find a very specific finding, retinal hemorrhage.

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Evaluation of an Emergency Department High-risk Bruising Screening Protocol

Cited by 18 publications

References 34 publications

Child Abuse Pediatricians Assess a Low Likelihood of Abuse in Half of 2890 Physical Abuse Consults

Child Abuse Pediatricians Assess a Low Likelihood of Abuse in Half of 2890 Physical Abuse Consults

A System-Wide Hospital Child Maltreatment Patient Safety Program

Diagnosis of Abusive Head Trauma : Neurosurgical Perspective

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