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Prior Emergency Department Utilization Association With Nonaccidental Trauma in Children
R Scott Eldredge1, Jefferson Lin2, Stephanie Zimmerman3
1Division of Pediatric Surgery, Department of Surgery, Phoenix Children's, Phoenix, Arizona; Department of Surgery, Mayo Clinic School of Medicine and Science, Phoenix, Arizona.
Insights
Prior emergency department (ED) visits are a significant risk factor for physical child abuse (PCA). Each additional ED visit increases the likelihood of PCA by 19%, suggesting a predictive pattern for nonaccidental trauma.
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.
Introduction:
Physical child abuse (PCA) is believed to occur in an escalating manner with multiple episodes occurring over time. This pattern may potentially lead to multiple emergency department (ED) visits, often to different EDs. The aim of this study was to evaluate prior ED utilization as a risk factor for PCA in children.
Materials And Methods:
A retrospective case-control study was conducted of children evaluated for potential PCA at a level I pediatric trauma center. Cases included patients deemed probable PCA by the hospital forensic team. Demographic data of cases was transferred to the Center for Health Information and Research for statewide matching with accidental injury controls based on age and time of injury. Additional information on all prior ED visits (for any reason) in the state within 4 y was extracted for all cases and controls. Logistic regression assessed the relationship of prior ED utilization with PCA for patients with ≥1 prior ED visits.
Results:
Of the total 518 patients identified, only 303 (58%) had at least one prior ED visit and were analyzed. PCA cases versus accidental injury controls were more likely to be younger (1.5 ± 1.8 versus 1.9 ± 2.0 y, P = 0.04), have Medicaid (86% versus 72%, P = 0.01), and ≥2 prior ED visits (62% versus 48%, odds ratio 1.76 [1.11-2.8] P = 0.02). On multivariable logistic regression controlling for patient age, race, and payer status, each additional prior ED visit increased the odds of PCA by 19% (adjusted odds ratio 1.19 [1.03 - 1.39], P = 0.02).
Conclusions:
Frequency of prior ED utilization is an independent risk factor for PCA. Each prior ED utilization increases a patient's odds for child abuse by 19%. A history of multiple prior ED may be used to help predict nonaccidental trauma.
