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Child physical abuse screening in a pediatric ED; Does TRAIN(ing) Help?
Theodore Heyming1,2, Chloe Knudsen-Robbins3, Supriya Sharma4
1Children's Health of Orange County, CHOC Hospital, 1201 W. La Veta Ave, Orange, CA, 92868, USA. Theyming@choc.org.
Insights
The Timely Recognition of Abusive INjuries (TRAIN) initiative increased skeletal survey rates in infants under six months old, aiding in the recognition of child physical abuse (CPA). This study examined TRAIN
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse Recognition
- Healthcare Quality Improvement
Background:
- Child maltreatment is a significant public health issue, often underdiagnosed by healthcare providers.
- The Timely Recognition of Abusive INjuries (TRAIN) collaborative was developed to improve screening for child physical abuse (CPA).
- This study evaluates the impact of implementing the TRAIN initiative at a specific pediatric trauma center.
Purpose of the Study:
- To assess the effect of the TRAIN initiative on the identification and management of sentinel injuries (SIS) in young children.
- To analyze changes in the incidence of SIS and the utilization of diagnostic procedures post-TRAIN implementation.
- To determine if the TRAIN initiative influenced the rate of repeat injuries in infants.
Main Methods:
- Retrospective chart review of Emergency Department (ED) visits for children under 6.01 months.
- Identification of sentinel injuries (SIS) based on specific diagnoses.
- Comparison of data from pre-TRAIN (January 2017-September 2018) and post-TRAIN (October 2019-July 2020) periods.
- Statistical analysis using Chi square, Fischer's exact test, and student's paired t-test.
Main Results:
- The incidence of SIS in children under 6.01 months remained stable pre- and post-TRAIN (2.8% vs 2.6%).
- A statistically significant increase in skeletal surveys for patients with SIS was observed post-TRAIN (17.1% vs 27.2%, p=0.01).
- No significant difference was found in the rate of repeat injuries before and after TRAIN implementation.
Conclusions:
- Implementation of the TRAIN initiative at this institution is associated with an increased rate of skeletal surveys for infants with sentinel injuries.
- The TRAIN initiative may enhance diagnostic evaluation for potential child physical abuse in young children.
- Further research is needed to confirm the long-term impact on patient outcomes.
Background:
Child maltreatment is distressingly prevalent yet remains under-recognized by healthcare providers. In 2015 the Ohio Children's Hospital Association developed the Timely Recognition of Abusive INjuries (TRAIN) collaborative in an effort to promote child physical abuse (CPA) screening. Our institution implemented the TRAIN initiative in 2019. The objective of this study was to examine the effects of the TRAIN initiative at this institution.
Methods:
In this retrospective chart review we recorded the incidence of sentinel injuries (SIS) in children presenting to the Emergency Department (ED) of an independent level 2 pediatric trauma center. SIS were defined and identified by a diagnosis of ecchymosis, contusion, fracture, head injury, intracranial hemorrhage, abdominal trauma, open wound, laceration, abrasion, oropharyngeal injury, genital injury, intoxication, or burn in a child < 6.01 months of age. Patients were stratified into pre-TRAIN (PRE), 1/2017-9/2018, or post-TRAIN (POST), 10/2019-7/2020, periods. Repeat injury was defined as a subsequent visit for any of the previously mentioned diagnoses within 12 months of the initial visit. Demographics/visit characteristics were analyzed using Chi square analysis, Fischer's exact test, and student's paired t-test.
Results:
In the PRE period, 12,812 ED visits were made by children < 6.01 months old; 2.8% of these visits were made by patients with SIS. In the POST period there were 5,372 ED visits, 2.6% involved SIS (p = .4). The rate of skeletal surveys performed on patients with SIS increased from 17.1% in the PRE period to 27.2% in the POST period (p = .01). The positivity rate of skeletal surveys in the PRE versus POST period was 18.9% and 26.3% respectively (p = .45). Repeat injury rates did not differ significantly in patients with SIS pre- versus post-TRAIN (p = .44).
Conclusion:
Implementation of TRAIN at this institution appears to be associated with increased skeletal survey rates.
