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Development of an electronic medical record-based child physical abuse alert system
Rachel P Berger1, Richard A Saladino1, Janet Fromkin1
1Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
Insights
Electronic medical record alerts can effectively identify young children at risk for physical abuse. This system demonstrated high sensitivity and specificity in detecting potential child abuse cases, aiding early intervention.
Area of Science:
- Pediatric Medicine
- Public Health
- Health Informatics
Background:
- Physical abuse is a significant cause of child injury and death.
- Physician screening for child abuse is inconsistent, even in high-risk scenarios.
- Early identification of abuse can lead to improved patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of an electronic medical record (EMR) alert system for identifying young children at risk of physical abuse.
- To assess the sensitivity, specificity, and predictive values of the EMR alert system.
Main Methods:
- Developed and implemented 30 age-specific triggers in an EMR system at a pediatric hospital.
- Ran the system in 'silent mode' for a defined period, with study personnel monitoring alerts.
- Calculated performance metrics including sensitivity, specificity, and predictive values for identifying physical abuse in children under 2 years old.
Main Results:
- The EMR alert system identified 226 children under 2 years old during the study period.
- The system achieved a sensitivity of 96.8% and a specificity of 98.5% for detecting physical abuse.
- Positive predictive value was 26.5%, and negative predictive value was 99.9%.
Conclusions:
- EMR-embedded triggers are a viable tool for identifying young children requiring evaluation for physical abuse.
- The system demonstrates high accuracy in flagging at-risk children, supporting timely intervention.
- This technology has the potential to improve the detection rates of child physical abuse.
Objective:
Physical abuse is a leading cause of pediatric morbidity and mortality. Physicians do not consistently screen for abuse, even in high-risk situations. Alerts in the electronic medical record may help improve screening rates, resulting in early identification and improved outcomes.
Methods:
Triggers to identify children < 2 years old at risk for physical abuse were coded into the electronic medical record at a freestanding pediatric hospital with a level 1 trauma center. The system was run in "silent mode"; physicians were unaware of the system, but study personnel received data on children who triggered the alert system. Sensitivity, specificity, and negative and positive predictive values of the child abuse alert system for identifying physical abuse were calculated.
Results:
Thirty age-specific triggers were embedded into the electronic medical record. From October 21, 2014, through April 6, 2015, the system was in silent mode. All 226 children who triggered the alert system were considered subjects. Mean (SD) age was 9.1 (6.5) months. All triggers were activated at least once. Sensitivity was 96.8% (95% CI, 92.4-100.0%), specificity was 98.5% (95% CI, 98.3.5-98.7), and positive and negative predictive values were 26.5% (95% CI, 21.2-32.8%) and 99.9% (95% CI, 99.9-100.0%), respectively, for identifying children < 2 years old with possible, probable, or definite physical abuse.
Discussion/Conclusion:
Triggers embedded into the electronic medical record can identify young children with who need to be evaluated for physical abuse with high sensitivity and specificity.
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