SCAN for Abuse: Electronic Health Record-Based Universal Child Abuse Screening

Area of Science:

• Pediatric Medicine
• Public Health
• Medical Informatics

Background:

• Subjective identification of child abuse in healthcare settings leads to errors.
• A systematic approach is needed to improve the detection of physical abuse.
• Electronic health record (EHR) systems offer a platform for systematic screening.

Purpose of the Study:

• To evaluate the implementation of an EHR-based universal Child Injury Screen (CIS).
• To assess the impact of CIS on improving the detection rates of child abuse.
• To compare child abuse reporting rates before and after CIS implementation.

Main Methods:

• Implemented a two-question CIS within EHR for children aged 5 or younger.
• Positive CIS responses triggered evaluation by a child abuse team.
• Analyzed patient data and compared Child Protective Services (CPS) reporting rates pre- and post-implementation.

Main Results:

• 14,150 patients were screened; 2.0% had positive CIS responses.
• 58.0% of positive CIS cases would have been missed without the screen.
• CPS reporting rates increased from 1.2 to 4.2 per 1000 children post-implementation.

Conclusions:

• The EHR-based CIS significantly increased the detection of suspected child abuse in young children.
• The CIS provides a systematic and effective method for identifying child abuse at the point of care.
• Implementation led to a higher rate of necessary evaluations and CPS reports.