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Child abuse and neglect presentations to a pediatric emergency department
Reza Keshavarz1, Rebekah Kawashima, Chris Low
1Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
Insights
This study on child abuse and neglect in a pediatric emergency department found that mothers were the most frequent perpetrators. Many cases, especially sexual abuse, lacked physical findings, highlighting the need for thorough evaluation.
Area of Science:
- Pediatrics
- Child Abuse and Neglect Epidemiology
- Social Work in Healthcare
Background:
- Child abuse and neglect remain significant public health concerns.
- Pediatric Emergency Departments (PEDs) are critical points for identifying and reporting child maltreatment.
- Understanding the epidemiology of reported abuse is crucial for targeted interventions.
Purpose of the Study:
- To describe the epidemiology of reported physical abuse, sexual abuse, and neglect in a metropolitan Pediatric Emergency Department (PED).
- To analyze demographic data, perpetrator information, injury patterns, and outcomes of reported child abuse cases.
- To assess the incidence of reported abuse and neglect compared to previous studies.
Main Methods:
- Retrospective chart review of cases reported to the Administration for Children's Services (ACS) from a teaching metropolitan PED (May 1996-December 1998).
- Data collection included victim demographics, medical history, previous PED visits, perpetrator details, and injury nature.
- Analysis of ACS investigation outcomes: 'indicated,' 'unfounded,' or undetermined.
Main Results:
- 106 cases of child abuse or neglect were reported.
- Physical abuse (55%) was most common, followed by neglect (30%) and sexual abuse (15%).
- Mothers (41%) were the most frequent suspected perpetrators; bruises were the most common injury (25%).
- Victims averaged 4.6 previous PED visits and 69% presented between 5 PM and 9 AM.
- Nearly 89% of victims had Medicaid or no insurance.
- ACS investigations deemed 46% of cases 'indicated' and 20% 'unfounded.'
- A significant proportion of sexual abuse cases lacked physical findings.
Conclusions:
- The incidence of reported abuse and neglect in this PED was lower than previously reported.
- The high percentage of cases without physical findings, particularly sexual abuse, underscores the importance of a comprehensive assessment for abuse and neglect.
- Maternal perpetration and the timing of presentations (evenings/nights) are key epidemiological features to consider in child protection efforts.
Abstract:
This study describes the epidemiology of reported abuse (physical, sexual, and neglect) in a teaching, metropolitan Pediatric Emergency Department (PED) with approximately 30,000 annual visits. A retrospective chart review was conducted of all cases from the PED that were referred to the Department of Social Work and reported to the Administration for Children's Services (ACS), the New York children's protective services, from May 1996 through December 1998. Demographic information about the victims as well as past medical history, number of previous PED visits, information about the perpetrator and the nature of the injuries were obtained. We identified 106 cases over this period of time that were reported for child abuse or neglect from the PED. Fifty-five percent of cases were reported for suspected physical abuse, 15% for sexual abuse, and 30% for neglect. The suspected perpetrator was the mother in 41% of cases and the father in 21% of cases. Bruises were the most frequent injury reported, seen in 25% of cases. The mean age of the patients was 6.4 years old. They averaged 4.6 previous PED visits. The majority of patients lived near the hospital. Sixty-nine percent of the patients presented for care between the hours of 5 PM and 9 AM. Most of the patients claimed their primary physician was located in a clinic near their home (44%). Only 12.7% were unsure of their primary physician. Significantly more victims (89%) had Medicaid or no insurance compared with other PED patients (71%). Victims did not live in zip codes with lower incomes compared with other PED patients. Upon complete investigation by ACS, 49 cases (46%) were deemed 'indicated,' 21 cases (20%) 'unfounded,' and for the remaining 36 cases (34%) follow-up information could not be determined. The incidence of reported abuse and neglect was lower than previous studies have shown. The majority of reported cases (especially those of sexual abuse) did not have any physical findings at the time of presentation, stressing the need of a careful search for both abuse and neglect.