Quality Improvement Initiative to Improve Abuse Screening Among Infants With Extremity Fractures

Area of Science:

• Pediatric medicine
• Medical quality improvement
• Child abuse detection

Background:

• Infants with extremity fractures require thorough evaluation for suspected physical abuse.
• Current diagnostic and consultation practices may be inconsistent.

Purpose of the Study:

• To assess the effectiveness of clinical pathway implementation and quality improvement (QI) interventions.
• To increase the rate of skeletal surveys (SS) and social work/Child Protection Team consultations for infants with extremity fractures.

Main Methods:

• Retrospective chart review of infants (<12 months) with extremity fractures.
• Implementation of QI interventions including clinical decision support and provider education.
• Statistical process control charts and logistic regression to analyze impact.

Main Results:

• Skeletal survey use increased from 40% to over 60% post-intervention.
• Consultation rates rose to nearly 67% during active QI, then settled at 60%.
• Lack of trauma history and specific fracture types (femur, humerus) predicted higher SS and consultation rates; 20% of SS revealed occult fractures.

Conclusions:

• Clinical pathway and QI interventions are effective in improving evaluation rates for abusive head trauma in infants.
• Targeted interventions can enhance the detection of occult fractures and facilitate necessary consultations.