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The Impact of an Emergency Department Bruising Pathway on Disparities in Child Abuse Evaluation
Caitlin E Crumm, Emily C B Brown, Surabhi B Vora
1Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA.
Insights
A standardized clinical pathway reduced socioeconomic disparities in reporting high-risk bruising to child protective services (CPS) and law enforcement (LE). This standardized approach may improve equity in child abuse evaluations.
Area of Science:
- Pediatrics
- Child Abuse and Neglect
- Health Equity
Background:
- Racial, ethnic, and socioeconomic disparities exist in medical evaluations and reporting for suspected child physical abuse.
- Standardized clinical pathways are increasingly used to improve consistency in healthcare.
- A standardized pathway for high-risk bruising was implemented in a hospital setting.
Purpose of the Study:
- To assess the impact of a standardized clinical pathway on disparities in the evaluation and reporting of high-risk bruising.
- To determine if standardization reduced existing racial, ethnic, and socioeconomic disparities.
Main Methods:
- Retrospective observational study of children with high-risk bruising evaluated in the emergency department.
- Comparison of outcomes (skeletal survey, child protective services (CPS) report, law enforcement (LE) report) before and after pathway implementation.
- Analysis of disparities across racial, ethnic, and socioeconomic groups.
Main Results:
- Children without private insurance had higher risks of CPS and LE reports pre-pathway.
- These socioeconomic disparities in reporting were not significant after pathway implementation.
- No significant associations were observed for race or ethnicity.
Conclusions:
- Standardized clinical pathways may mitigate socioeconomic disparities in reporting high-risk bruising.
- Further research is needed to fully understand and address disparities in child abuse assessment and reporting.
Objectives:
Previous research has shown racial, ethnic, and socioeconomic disparities in provider medical evaluations and reporting to child protective services (CPS) and law enforcement (LE) for cases of suspected child physical abuse. Our hospital standardized evaluation and reporting of high-risk bruising using a clinical pathway. We aimed to assess whether standardization impacted disparity.
Methods:
We performed a retrospective observational study including children evaluated in the emergency department who had a social work consult for concern for child abuse or neglect between June 2012 and December 2019. From this group, we identified children with high-risk bruising. We compared outcomes (receipt of skeletal survey, CPS report, or LE report) before and after implementation of a standard bruising evaluation pathway to determine how the intervention changed practice among various racial, ethnic, and socioeconomic groups.
Results:
During the study period, 2129 children presented to the ED and received a social work consult for child abuse or neglect. Of these, 333 had high-risk bruising. Children without private insurance had a higher risk of having a CPS (adjusted relative risk, 1.32; 95% confidence interval, 1.09-1.60) or LE (adjusted relative risk, 1.48; 95% confidence interval, 1.11-1.97) report prepathway, but not after pathway implementation. No significant associations were seen for race or ethnicity.
Conclusions:
A standardized clinical pathway for identification and evaluation of high-risk bruising may help to decrease socioeconomic disparities in reporting high-risk bruising. Larger studies are needed to fully evaluate disparities in assessment and reporting of child abuse.
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