Child maltreatment in U.S. emergency departments: Imaging and admissions

Area of Science:

• Pediatric Emergency Medicine
• Child Abuse and Neglect
• Healthcare Services Research

Background:

• Child maltreatment is a significant public health concern requiring timely and appropriate medical evaluation in emergency departments (EDs).
• Hospital volume may influence the diagnostic and treatment pathways for suspected child abuse cases.

Purpose of the Study:

• To determine national estimates of ED visits for children with definitive and suggestive maltreatment.
• To analyze admission/transfer ratios and screening practices (skeletal surveys, head CT) based on pediatric ED volume.

Main Methods:

• Utilized the 2012 Nationwide Emergency Department Sample (NEDS) for children under 10 years with definitive or suggestive maltreatment.
• Compared admission/transfer ratios and imaging screening ratios across low, medium, and high pediatric ED volume hospitals using multivariable logistic regression.

Main Results:

• In 2012, there were an estimated 14,457 ED visits for definitive maltreatment and 103,392 for suggestive maltreatment in children under 10.
• High-volume hospitals showed higher odds of admission/transfer for definitive maltreatment cases (AOR=1.74) and medium-volume hospitals for suggestive cases (AOR=1.24).
• High-volume hospitals were more likely to perform skeletal surveys on children under 2 with suspected abuse (AOR=3.32), but head CT ratios were not volume-dependent.

Conclusions:

• Low-volume EDs were less likely to admit or transfer children with maltreatment compared to high-volume EDs.
• Screening practices for suspected physical abuse varied by hospital volume, with low-volume EDs less likely to utilize skeletal surveys for young children.
• ED volume impacts management decisions and screening protocols for child maltreatment.