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Emergency Department Utilization in Children <36 Months Is Not an Independent Risk Factor for Maltreatment

Emily C MacNeill1, Whitney Cabey1,2,3, Robert Kluge4

  • 1Carolinas Healthcare System, Charlotte, NC.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|October 8, 2016
PubMed

Insights

High-frequency emergency department (ED) use in early childhood is not a direct indicator of child maltreatment. Confounding factors, not high-frequency use alone, influence child protective services (CPS) involvement.

Area of Science:

  • Pediatric emergency medicine
  • Child maltreatment research
  • Public health surveillance

Background:

  • Early childhood high-frequency use (HFU) of the emergency department (ED) is considered a potential marker for increased risk of child maltreatment.
  • HFU was defined as five or more pediatric ED visits for children aged 0-36 months in a prior analysis.
  • This study aimed to investigate if early childhood HFU is associated with a higher likelihood of reported maltreatment.

Purpose of the Study:

  • To determine if children with early childhood high-frequency use (HFU) of the pediatric emergency department (PED) have a higher likelihood of subsequent child protective services (CPS) intervention.
  • To assess the independent association between PED HFU and child maltreatment.
  • To evaluate the utility of PED utilization as a marker for identifying children at risk of maltreatment.

Main Methods:

  • A single-center, cross-sectional, observational study design was employed.
  • Data on child protective services (CPS) involvement were obtained from a state Department of Social Services database.
  • Subjects meeting criteria for PED HFU were compared with sex, race, and ethnicity-matched controls using multivariable analyses.

Main Results:

  • While CPS involvement was more frequent in the HFU group, this association was confounded by other factors.
  • Confounding variables included African American race, prior hospital admissions, and social work consultations.
  • High-frequency ED use, in isolation, was not found to be an independent risk factor for significant CPS intervention.

Conclusions:

  • Objective assessments like pediatric emergency department (PED) utilization can be potential markers for identifying children at risk of maltreatment.
  • However, numerous risk factors contribute to increased PED utilization, acting as confounders for this marker.
  • Further research is needed to develop reliable methods for identifying children at risk for maltreatment within the emergency department setting.
Abstract

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