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Urinalysis in Suspected Child Abuse Evaluation in the Emergency Department
Nidhi V Singh1, Katrin Lichtsinn2, Molly Ray3
1From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Insights
Urinalysis alone did not diagnose intra-abdominal injury (IAI) in abused infants. This testing also caused delays in patient care, highlighting the need for improved diagnostic strategies for child abuse injuries.
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse Detection
- Diagnostic Accuracy
Background:
- Intra-abdominal injury (IAI) is a significant cause of mortality in abused children.
- Diagnosing IAI in infants is challenging due to subtle clinical signs and limited communication.
Purpose of the Study:
- To determine if urinalysis alone can identify intra-abdominal injury (IAI) in suspected child abuse cases.
- To assess delays in patient disposition caused by urinalysis testing.
Main Methods:
- Retrospective cohort study of infants (0-12 months) evaluated for suspected abuse.
- Analysis of skeletal surveys, urinalysis, and examination findings.
- Calculation of delays between test result acquisition.
Main Results:
- Only one of 613 subjects had IAI; urinalysis did not identify this case uniquely.
- Hematuria was present in two subjects, with one having a urinary tract infection and the other blood from catheterization.
- Urinalysis was delayed for 78% of subjects, adding a median of 93 minutes to evaluation time.
Conclusions:
- Urinalysis alone did not lead to the diagnosis of IAI in this cohort.
- Delayed urinalysis results contributed to prolonged emergency department stays.
- Current diagnostic approaches for IAI in abused infants require refinement.
Background:
Intra-abdominal injury (IAI) is the second leading cause of mortality in abused children. It is challenging to identify in young patients due to their limited verbal skills, delayed symptoms, less muscular abdominal wall, and limited bruising.
Methods:
We conducted a retrospective cohort study of children aged 0 to 12 months who were evaluated in the emergency department for suspected child abuse with a skeletal survey and urinalysis between January 1, 2015, and December 31, 2017. Our primary objective was to identify the proportion of IAI cases identified by urinalysis alone (>10 RBC/HPF) and not by examination findings or other laboratory results. A secondary objective was to quantify potential delay in disposition while waiting for urinalysis results, calculated as the length of time between receiving skeletal survey and laboratory results and receiving urinalysis results.
Results:
Six hundred thirteen subjects met our inclusion criteria; two subjects had hematuria, one of whom had a urinary tract infection. The other was determined to have blood from a catheterized urine specimen. One subject was found to have an IAI. We further found that urinalysis was delayed for 78% of subjects and took a median of 93 [interquartile range, 46-153] minutes longer than imaging and/or laboratories.
Conclusions:
No subjects were diagnosed with abdominal trauma based on urinalysis during evaluation in the emergency department who would not have been identified by other standard testing. In addition, patients' disposition was delayed while waiting for urinalysis.
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