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Improved Detection of Child Maltreatment with Routine Screening in a Tertiary Care Pediatric Hospital
Srinivasan Suresh1, Emily Heineman2, Lisa Meyer3
1Division of Health Informatics, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA; Division of Emergency Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
Insights
Routine child abuse screening, like the Pittsburgh Child Abuse Screening Tool (P-CAST), significantly improves the identification of suspected child maltreatment in pediatric emergency departments. This systematic approach may help reduce racial disparities in reporting.
Area of Science:
- Pediatric Emergency Medicine
- Child Maltreatment Detection
- Clinical Decision Support Systems
Background:
- Electronic health record-embedded Child Abuse Clinical Decision Support Systems (CA-CDSS) often rely on passive triggers.
- Existing systems may not capture all cases of suspected child maltreatment.
- There is a need to enhance the identification of child abuse in pediatric settings.
Purpose of the Study:
- To evaluate the effectiveness of adding active, routine child abuse screening to a preexisting CA-CDSS.
- To determine the impact of the Pittsburgh Child Abuse Screening Tool (P-CAST) in a pediatric emergency department.
- To assess potential racial disparities in screening and reporting.
Main Methods:
- The Pittsburgh Child Abuse Screening Tool (P-CAST) was implemented for children under 13 and nonverbal children over 13.
- P-CAST was layered onto an existing CA-CDSS with passive triggers, alerts, and order sets.
- Data were collected over a 6-month period in a pediatric tertiary care center.
Main Results:
- 1.8% of younger children and 1.6% of older nonverbal children screened positive via P-CAST.
- Half of positive P-CAST screens also triggered the CA-CDSS; the other half were identified solely by P-CAST.
- 19% of positive P-CAST cases were reported to Child Protective Services (CPS); no racial disparities were observed.
Conclusions:
- Active routine screening (P-CAST) enhances child maltreatment identification beyond passive CA-CDSS triggers.
- Systematic screening may mitigate racial disparities in identifying and reporting suspected child maltreatment.
- Layering P-CAST on CA-CDSS improves detection rates in pediatric emergency settings.
Objectives:
To evaluate the impact of layering routine child abuse screening on top of a preexisting electronic health record-embedded Child Abuse Clinical Decision Support System (CA-CDSS) in a pediatric emergency department.
Study Design:
The Pittsburgh Child Abuse Screening Tool (P-CAST) was performed in all children aged <13 years and in nonverbal children aged ≥13 years who presented to a pediatric tertiary care center over a 6-month period. The P-CAST was layered on top of a preexisting CA-CDSS that included passive triggers, alerts, and abuse-specific order sets.
Results:
Of the 28 797 screens performed, 1.8% were positive in children aged <13 years and 1.6% were positive in nonverbal children aged ≥13 years. One-half of the children with a positive P-CAST also triggered the CA-CDSS; the other one-half triggered only because of the P-CAST. Nineteen percent of the patients with a positive P-CAST were reported to Child Protective Services (CPS). There was no relationship between race and the odds of a positive P-CAST or between race and the likelihood of a report being made to CPS.
Conclusions:
Active routine child abuse screening improves identification of suspected child maltreatment in a children's hospital above and beyond what is identified with a CA-CDSS, which depends on passive triggers. The lack of a relationship between race and a positive P-CAST or a report to CPS suggest that systematic child abuse screening may mitigate well-recognized racial disparities in identifying and reporting suspected child maltreatment.
