Implementation of routine electronic health record-based child abuse screening in General Emergency Departments

Rumball-Smith, Juliet; Fromkin, Janet; Rosenthal, Bruce; Shane, Debra; Skrbin, Janet; Bimber, Tammy; Berger, Rachel P.

doi:10.1016/j.chiabu.2018.08.008

Cited by 50 publications

(38 citation statements)

References 32 publications

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“…Epidemiological data may provide insight into how the pandemic influenced children, for example, by analyzing hospital and emergency room visits preceding, during, and after the Covid-19 period (cf. Rumball-Smith et al, 2018). But notable complications limit such data.…”

Section: Implications and Recommendationsmentioning

confidence: 99%

The Perfect Storm: Hidden Risk of Child Maltreatment During the Covid-19 Pandemic

et al. 2020

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The Covid-19 pandemic upended the country, with enormous economic and social shifts. Given the increased contact from families living in virtual confinement coupled with massive economic disarray, the Covid-19 pandemic may have created the ideal conditions to witness a rise in children’s experience of abuse and neglect. Yet such a rise will be difficult to calculate given the drop in official mechanisms to track its incidence. The current investigation utilized two studies conducted early in the pandemic to evaluate maltreatment risk. In the first cross-sectional study, parents ( n = 405) reported increased physical and verbal conflict and neglect which were associated with their perceived stress and loneliness. In the second study, parents ( n = 106) enrolled in a longitudinal study reported increased parent-child conflict, which was associated with concurrent child abuse risk, with several links to employment loss, food insecurity, and loneliness; findings also demonstrated increases in abuse risk and psychological aggression relative to pre-pandemic levels. Findings are discussed in the context of a reactive welfare system rather than a pro-active public-health oriented approach to child maltreatment, connecting with families through multiple avenues. Innovative approaches will be needed to reach children faced with maltreatment to gauge its scope and impact in the pandemic’s aftermath.

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Section: Implications and Recommendationsmentioning

confidence: 99%

The Perfect Storm: Hidden Risk of Child Maltreatment During the Covid-19 Pandemic

et al. 2020

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“…[15][16][17][18][19] Electronic health record-based clinical decision support and mobile apps to aid medical providers in identifying cases of child abuse have been developed and show promise in increasing CPS referrals for suspected CAN. 20 Recent studies examining factors related to improving aspects of pediatric care in community EDs have found that the presence of a pediatric emergency care coordinator who serves as a clinical champion for pediatrics improved pediatric readiness and was associated with having quality improvement plans and policies addressing the needs of children. 10,21,22 We aimed to leverage this novel approach of using a pediatric champion who was provided with access to experts at an academic medical center, and resources and training focused on CAN, by implementing the Community ED CAN Program.…”

mentioning

confidence: 99%

A Qualitative Study Examining Stakeholder Perspectives of a Local Child Abuse Program in Community Emergency Departments

Tiyyagura

Schaeffer

Gawel

et al. 2019

Academic Pediatrics

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The acute nature of an injury and/or lack of access or availability of primary care may lead victims of child abuse and/or neglect (CAN) to seek care in emergency departments (EDs) where ED providers may be the only medical contact to recognize abuse or neglect. Studies of children presenting to EDs indicate that up to 2% have injuries for which CAN should be considered. 1-4 In contrast, of children who died or suffered serious injuries from abuse, about 30% had been previously evaluated for injuries that were not recognized as abusive by a health care provider, often in EDs. 5-9 ED providers must recognize those injuries suggestive of CAN and report them to child protective services (CPS) in order to prevent additional injury or death. Recognition and reporting of CAN are especially important in community EDs, where the vast majority of emergency care for children in the U.S. is provided. 10-12 Providers in community EDs care for both children and adults, are exposed to fewer pediatric cases, and have limited access to subspecialist consultation. 10-12 Evidence suggests that abusive injuries are also missed more frequently in community vs pediatric EDs due to lack of recognition of abuse-related injuries. 13,14

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“…Emerging CDSSs that utilize more complex programming algorithms to focus on prospective screening have demonstrated success in identifying children whose presenting signs and symptoms suggest an increased risk of abuse (Rumball-Smith et al, 2018). But to our knowledge, no simple alert systems such as the CPAS described here has been evaluated as a mechanism for screening for child maltreatment.…”

Section: Discussionmentioning

confidence: 99%

What We Can Learn From Failure: An EHR-Based Child Protection Alert System

et al. 2019

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This study aimed to evaluate the efficacy of a newly implemented Child Protection Alert System (CPAS) that utilizes triggering diagnoses to identify children who have been confirmed/strongly suspected as maltreated. We retrospectively reviewed electronic health records (EHRs) of 666 patients evaluated by our institution’s child protection team between 2009 and 2014. We examined each EHR for the presence of a pop-up alert, a persistent text-based visual alert, and diagnoses denoting child maltreatment. Diagnostic accuracy of the CPAS for child maltreatment identification was assessed. Of 323 patients for whom child maltreatment was confirmed/strongly suspected, 21.7% (70/323) had a qualifying longitudinal diagnosis listed. The pop-up alert fired in 14% of cases (45/323) with a sensitivity and specificity of 13.9% (95% CI [10.4%, 18.2%]) and 100% (95% CI [98.9%, 100.0%]), respectively. The text-based visual alert displayed in 44 of 45 cases. The CPAS is a novel simple way to support clinical decision-making to identify and protect children at risk of (re)abuse. This study highlights multiple barriers that must be overcome to effectively design and implement a CPAS to protect at-risk children.

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Implementation of routine electronic health record-based child abuse screening in General Emergency Departments

Cited by 50 publications

References 32 publications

The Perfect Storm: Hidden Risk of Child Maltreatment During the Covid-19 Pandemic

The Perfect Storm: Hidden Risk of Child Maltreatment During the Covid-19 Pandemic

A Qualitative Study Examining Stakeholder Perspectives of a Local Child Abuse Program in Community Emergency Departments

What We Can Learn From Failure: An EHR-Based Child Protection Alert System

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