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How useful was a paediatric physical abuse screening project in a rural Australian emergency department?
John van Bockxmeer1, Lesley Enzor1, Marshall Makate2
1Emergency Department, WA Country Health Service, Perth, Western Australia, Australia.
Insights
Implementing a physical abuse screening tool in emergency departments improved documentation and medical decision-making for child safety, without increasing patient re-presentations.
Area of Science:
- Pediatric emergency medicine
- Child abuse and neglect research
- Public health interventions
Background:
- Children with non-accidental injuries face a higher risk of mortality.
- Evidence for routine use of physical abuse screening tools in emergency departments (EDs) is limited.
- This study evaluates a project implementing a screening tool for physical abuse in a rural Australian ED.
Purpose of the Study:
- To assess the reliability and effectiveness of a physical abuse screening tool in a medium-sized rural Australian ED.
- To determine if risk-screening improves outcomes for children presenting with injuries.
- To evaluate a project including a screening tool and case-matching from multiple sources.
Main Methods:
- A 16-month retrospective pre-/post-implementation study of pediatric injury, burn, or poisoning cases (under 16 years).
- Screening tool implementation within a Clinical Pathway Algorithm (CPA).
- Multivariable logistic regression compared pre- and post-implementation cases, analyzing outcomes and trends.
Main Results:
- 1469 presentations investigated; no statistically significant difference in overall cases pre- vs. post-implementation.
- Tool use significantly improved documentation (OR 7.73), increased child protection referrals (OR 5.50), and decreased hospital admissions (OR 0.42).
- Screening tool sensitivity was 62.3% and specificity 79.7%; re-presentation rates remained unchanged.
Conclusions:
- The implemented ED pediatric physical abuse project enhanced safety behaviors and documentation quality.
- The screening tool aided medical decision-making without increasing re-presentations.
- ED clinicians can utilize similar CPAs for safety concerns, but resources are needed for managing false-positive referrals.
Objective:
Children with non-accidental injuries have increased risk of future death. There is insufficient evidence for widespread physical abuse screening tool use in the ED. This study assesses the utility of a physical abuse project that includes the implementation of a screening tool with case-matching from multiple sources. It aims to confirm whether risk-screening in a medium-sized rural Australian ED is reliable and will improve outcomes.
Methods:
This is a 16-month ED retrospective pre-/post-implementation study of all injury, burn or poisoning cases 16 years and under during a paediatric physical abuse safety project which included a screening tool. Presentations with potential physical abuse were filtered by ICD-10 codes and reviewed. Multivariable logistic regression models compared pre- and post-implementation cases. Analyses examined outcomes, trends and interrogated the screening tool which formed a Clinical Pathway Algorithm (CPA).
Results:
A total of 1469 presentations underwent investigation: 747 pre-implementation and 722 post-implementation. Pearson's χ2 test showed statistically insignificant differences. If tool used, documentation improved (odds ratio [OR] 7.73; 95% confidence interval [CI] 4.91-12.18), child protection service referrals increased (OR 5.50; 95% CI 1.82-16.61) and hospital admissions decreased (OR 0.42; 95% CI 0.22-0.79). Re-presentation rates stayed the same. Increased physical abuse was associated with screening factors including carer behavioural concerns, inadequate supervision, delayed presentation, repeat and unexplained injuries (ORs/CIs in an accompanying Table 4). Screening tool sensitivity was 62.3% and specificity 79.7%.
Conclusion:
Implementing this ED paediatric physical abuse project improved safety behaviours and best-practice documentation. The tool improved medical decision making without increased re-presentations. ED clinicians may use similar CPAs to help review safety concerns and facilitate discharge; however, resources are needed to investigate referrals flagged due to false-positive rates.
