Pediatric Trauma Documentation

Boyce, Mary C.; Melhorn, Katherine J.; Vargo, Geraldine

doi:10.1001/archpedi.1996.02170320076013

Cited by 29 publications

(3 citation statements)

References 9 publications

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“…The data on abuse includes all types of maltreatment including sexual abuse, neglect, non-fracture physical abuse, and fractures. Despite the predominance of unsubstantiated cases, some studies suggest fractures are not being reported accurately due to charting deficiencies [ 34 – 36 ]. We did not evaluate charting deficiencies in the current study.…”

Section: Discussionmentioning

confidence: 99%

Identifying non-accidental fractures in children aged <2 years

Leaman

Hennrikus

Bresnahan

2016

Journal of Children's Orthopaedics

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PurposeFractures are the second most common presentation of child abuse following soft-tissue bruising and burns. It is often difficult to determine potential abuse in a child presenting with a non-rib fracture(s) and without soft-tissue injuries.MethodsOne hundred and fifteen consecutive patients aged ≤2 years who presented with a fracture between January 2010 and June 2012 to our emergency department (ED) or pediatric fracture clinic were retrospectively analyzed. Statistical analyses were carried out for non-accidental fractures based on age (<1 year vs 1–2 years), location of presentation (ED vs pediatric fracture clinic), type of long bone fracture, number of fractures, and patient demographics.ResultsFractures in 19 of 115 (17 %) patients were reported as non-accidental trauma (NAT). Eighty (70 %) of the 115 patients first reported to the ED. Thirty-two percent of fractures in children aged <1 year and 5 % of fractures in children aged 1–2 years were reported as NAT (p < 0.001). Sixteen of 19 (84 %) patients reported for abuse had multiple fractures; 15 of these patients were aged <1 year. Eight of 11 (73 %) reported femoral fractures were transverse fractures. Corner fractures (12) only occurred in children aged <1 year and never occurred in isolation; all of them were reported as NAT. Four of 60 patients (7 %) with commercial insurance and 15 of 55 patients (28 %) with Medicaid were reported as NAT.ConclusionsAge less than 1 year, multiple fractures, corner fractures, transverse fractures, and covered by Medicaid were the most common factors associated with reporting of NAT.

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Section: Discussionmentioning

confidence: 99%

Identifying non-accidental fractures in children aged <2 years

Leaman

Hennrikus

Bresnahan

2016

Journal of Children's Orthopaedics

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“…This explains why a number of practical guidelines to differentiate abusive from accidental SFs have been prepared (9,10). However, patient assessment for abusive SFs is often suboptimal (11)(12)(13). Main objectives of this study were to evaluate the characteristics of SFs of children ≤3 years of age presenting to the Emergency Room (ER) of a Children's Teaching Hospital over a 12-year period and the attention paid by ER physicians to the identification of the indicators that increase suspicion of NAF and that suggest referring of the patient to the child protection agencies.…”

Section: Introductionmentioning

confidence: 99%

Recording Risk Factors of Physical Abuse in Children Younger Than 36 Months With Bone Fractures: A 12-Years Retrospective Study in an Italian General Hospital Emergency Room

et al. 2020

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Skeletal fractures (SFs) are very common in pediatrics. In some cases, they are secondary to child abuse. Differentiation of accidental from non-accidental fractures (NAFs) is essential as in abused children risk of further injuries leading to severe clinical problems and death is significant. Main objectives of this study were to evaluate the characteristics of SFs of children ≤3 years of age presenting to the Emergency Room (ER) of a Children's Teaching Hospital over a 12-year period and the attention paid by ER physicians to the identification of the indicators that increase suspicion of NAF and that suggest referring of the patient to the child protection agencies. This is a descriptive, retrospective study of the medical records of all the pediatric patients ≤ 36 months of age admitted to the ER of the Azienda Ospedaliera

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“…Limbos et al concluded that the majority of records contained “inadequate data to determine retrospectively if the diagnosis of child maltreatment had ever been considered by the evaluator” [11]. Boyce et al (1996) reported that only one-third of paediatric trauma cases had sufficient documentation to identify potential abuse from medical records [12]. …”

Section: Introductionmentioning

confidence: 99%

Quantity of documentation of maltreatment risk factors in injury-related paediatric hospitalisations

McKenzie

Scott

2012

BMC Public Health

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BackgroundWhile child maltreatment is recognised as a global problem, solid epidemiological data on the prevalence of child maltreatment and risk factors associated with child maltreatment is lacking in Australia and internationally. There have been recent calls for action to improve the evidence-base capturing and describing child abuse, particularly those data captured within the health sector. This paper describes the quantity of documentation of maltreatment risk factors in injury-related paediatric hospitalisations in Queensland, Australia.MethodsThis study involved a retrospective medical record review, text extraction and coding methodology to assess the quantity of documentation of risk factors and the subsequent utility of data in hospital records for describing child maltreatment and data linkage to Child Protection Service (CPS).ResultsThere were 433 children in the maltreatment group and 462 in the unintentional injury group for whom medical records could be reviewed. Almost 93% of the maltreatment code sample, but only 11% of the unintentional injury sample had documentation identified indicating the presence of any of 20 risk factors. In the maltreatment group the most commonly documented risk factor was history of abuse (41%). In those with an unintentional injury, the most commonly documented risk factor was alcohol abuse of the child or family (3%). More than 93% of the maltreatment sample also linked to a child protection record. Of concern are the 16% of those children who linked to child protection who did not have documented risk factors in the medical record.ConclusionGiven the importance of the medical record as a source of information about children presenting to hospital for treatment and as a potential source of evidence for legal action the lack of documentation is of concern. The details surrounding the injury admission and consideration of any maltreatment related risk factors, both identifying their presence and ruling them out are required for each and every case. This highlights the need for additional training for clinicians to understand the importance of their documentation in child injury cases.

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Pediatric Trauma Documentation

Cited by 29 publications

References 9 publications

Identifying non-accidental fractures in children aged <2 years

Identifying non-accidental fractures in children aged <2 years

Recording Risk Factors of Physical Abuse in Children Younger Than 36 Months With Bone Fractures: A 12-Years Retrospective Study in an Italian General Hospital Emergency Room

Quantity of documentation of maltreatment risk factors in injury-related paediatric hospitalisations

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