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SCAN for Abuse: Electronic Health Record-Based Universal Child Abuse Screening
Nolan R Martin1, Anneke L Claypool2, Modupeola Diyaolu3
1Eastern Virginia Medical School, Norfolk, VA, USA.
Insights
An electronic health record (EHR)-based Child Injury Screen (CIS) improved the detection of suspected child abuse in young children. This systematic approach identified more cases than traditional methods, leading to increased reporting to Child Protective Services (CPS).
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.
Background:
Identification of physical abuse at the point of care without a systematic approach remains inherently subjective and prone to judgement error. This study examines the implementation of an electronic health record (EHR)-based universal child injury screen (CIS) to improve detection rates of child abuse.
Methods:
CIS was implemented in the EHR admission documentation for all patients age 5 or younger at a single medical center, with the following questions. 1) "Is this patient an injured/trauma patient?" 2) "If this is a trauma/injured patient, where did the injury occur?" A "Yes" response to Question 1 would alert a team of child abuse pediatricians and social workers to determine if a patient required formal child abuse clinical evaluation. Patients who received positive CIS responses, formal child abuse work-up, and/or reports to Child Protective Services (CPS) were reviewed for analysis. CPS rates from historical controls (2017-2018) were compared to post-implementation rates (2019-2021).
Results:
Between 2019 and 2021, 14,150 patients were screened with CIS. 286 (2.0 %) patients screened received positive CIS responses. 166 (58.0 %) of these patients with positive CIS responses would not have otherwise been identified for child abuse evaluation by their treating teams. 18 (10.8 %) of the patients identified by the CIS and not by the treating team were later reported to CPS. Facility CPS reporting rates for physical abuse were 1.2 per 1000 admitted children age 5 or younger (pre-intervention) versus 4.2 per 1000 (post-intervention).
Conclusions:
Introduction of CIS led to increased detection suspected child abuse among children age 5 or younger.
Level Of Evidence:
Level II.
Type Of Study:
Study of Diagnostic Test.
