Prior Emergency Department Utilization Association With Nonaccidental Trauma in Children

Area of Science:

• Pediatrics
• Forensic Medicine
• Public Health

Background:

• Physical child abuse (PCA) is often a pattern of escalating violence.
• Multiple emergency department (ED) visits may indicate recurrent abuse.
• Evaluating prior ED utilization can identify children at risk for PCA.

Purpose of the Study:

• To determine if prior emergency department (ED) utilization is a risk factor for physical child abuse (PCA).
• To assess the relationship between the frequency of ED visits and the likelihood of PCA.

Main Methods:

• Retrospective case-control study at a pediatric trauma center.
• Compared children with probable PCA to accidental injury controls.
• Analyzed statewide emergency department (ED) visit data for up to 4 years prior to the index visit.

Main Results:

• Children with PCA were more likely to have had prior ED visits compared to controls.
• Each additional prior ED visit was associated with a 19% increase in the odds of PCA.
• Prior ED utilization remained a significant independent risk factor after controlling for demographic variables.

Conclusions:

• Frequent prior emergency department (ED) visits are an independent predictor of physical child abuse (PCA).
• A history of multiple ED visits may aid in identifying nonaccidental trauma.
• Targeted interventions can be considered for children with a pattern of frequent ED utilization.