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Association of injury visits in children and child maltreatment reports
Maria I Spivey1, Patricia G Schnitzer, Robin L Kruse
1Department of Pediatrics, Division of Emergency Medicine/Child Protection and Forensic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
Insights
Children with multiple injury-related Emergency Department (ED) visits are at higher risk for child maltreatment reports. Two or more ED visits significantly increase the likelihood of a confirmed maltreatment report.
Area of Science:
- Pediatric Emergency Medicine
- Child Maltreatment Research
- Public Health Surveillance
Background:
- Childhood injuries are a significant cause of morbidity and a common indicator of maltreatment, particularly in young children.
- Understanding the link between injury-related healthcare encounters and child protective services (CPS) involvement is crucial for early intervention.
Purpose of the Study:
- To investigate the association between injury-related Emergency Department (ED) visits in young children (0-4 years) and subsequent child maltreatment reports.
- To determine if the number of ED visits correlates with the risk of a CPS report or a substantiated maltreatment finding.
Main Methods:
- Retrospective analysis of injury-related ED visits for children aged 0-4 in Missouri during 2000.
- Data linkage between ED visit records and Missouri Child Protective Services (CPS) reports from 2000-2001.
- Calculation of relative risks (RR) for CPS reports and substantiated reports based on the number of prior ED visits.
Main Results:
- A total of 50,068 children experienced at least one injury-related ED visit.
- Children with two injury-related ED visits had a 1.9 times higher risk of a CPS report (RR 1.9, 95% CI 1.8-2.0) and 2.5 times higher risk of a substantiated report (RR 2.5, 95% CI 2.1-2.9) compared to those with one visit.
- Children with four or more ED visits showed substantially increased risks for both CPS reports (RR 3.8, 95% CI 3.0-4.7) and substantiated reports (RR 4.7, 95% CI 2.4-9.2).
Conclusions:
- Multiple injury-related ED visits in young children are significantly associated with an increased likelihood of being reported for and confirmed as experiencing child maltreatment.
- This finding highlights the potential of ED visits as a screening indicator for child maltreatment risk, warranting further investigation and potential intervention strategies.
Abstract:
Injuries are a leading cause of childhood morbidity and are also common manifestations of child maltreatment, especially among young children. In an effort to determine whether injury-related Emergency Department (ED) visits among children aged 0 to 4 years were associated with child maltreatment reports, we identified all children with at least one injury-related ED visit in Missouri during 2000. Data on these injured children were linked to Missouri Child Protective Services (CPS) child abuse and neglect reports for 2000 and 2001. There were 50,068 children with at least one injury-related ED visit. Using children with one injury-related ED visit as the reference category, we calculated the relative risk of having a CPS report (or a substantiated report) for children with two, three, and four or more ED visits before a CPS report (or substantiated report). Compared to children with one visit, children with two visits were more likely to have a CPS report (relative risk [RR] 1.9; 95% confidence interval [CI] 1.8-2.0) and a substantiated report (RR 2.5; 95% CI 2.1-2.9). For children with four or more visits, the relative risk of a report and substantiated report was 3.8 (95% CI 3.0-4.7) and 4.7 (95% CI 2.4-9.2), respectively. Children with two or more injury-related ED visits in 1 year are more likely to be reported for child maltreatment and to have a substantiated report.
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