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What We Can Learn From Failure: An EHR-Based Child Protection Alert System

Conrad Krawiec1, Seth Gerard2, Sarah Iriana3

  • 1Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Children's Hospital, Hershey, PA, USA.

Child Maltreatment
|May 30, 2019
PubMed

Insights

The Child Protection Alert System (CPAS) shows low sensitivity in identifying child maltreatment, despite high specificity. Further improvements are needed for effective child protection in clinical settings.

Area of Science:

  • Pediatrics
  • Public Health
  • Health Informatics

Background:

  • Child maltreatment poses significant risks to child well-being.
  • Effective identification systems are crucial for timely intervention and protection.
  • Existing clinical decision support tools for child protection require evaluation.

Purpose of the Study:

  • To evaluate the diagnostic accuracy and efficacy of a novel Child Protection Alert System (CPAS).
  • To assess the system's ability to identify children with confirmed or suspected maltreatment using triggering diagnoses.
  • To identify barriers in the design and implementation of CPAS for protecting at-risk children.

Main Methods:

  • Retrospective review of 666 electronic health records (EHRs) of patients evaluated by a child protection team (2009-2014).
  • Analysis of EHRs for the presence of pop-up alerts, text-based visual alerts, and qualifying diagnoses indicative of child maltreatment.
  • Assessment of the CPAS's diagnostic accuracy, including sensitivity and specificity for child maltreatment identification.

Main Results:

  • Only 21.7% of children with confirmed/suspected maltreatment had a qualifying longitudinal diagnosis listed.
  • The pop-up alert demonstrated low sensitivity (13.9%) but 100% specificity.
  • The text-based visual alert was present in 44 out of 45 relevant cases, indicating good visibility once triggered.

Conclusions:

  • The CPAS offers a potential method for supporting clinical decision-making in identifying children at risk of abuse.
  • Significant barriers exist in the effective design and implementation of CPAS, particularly concerning alert sensitivity.
  • Further research and system refinement are necessary to enhance CPAS efficacy in protecting vulnerable children.

Keywords:
abusedecision-makingprevention

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