Sentinel Injuries in Emergency Departments and Subsequent Serious Injury in Children

Area of Science:

• Pediatrics
• Child Abuse Research
• Emergency Medicine

Background:

• Sentinel injuries in young children can indicate physical abuse, necessitating early identification.
• Widespread screening for child abuse after sentinel injuries may lead to unintended harm.
• Understanding the risk of serious abusive injury after an emergency department (ED) sentinel injury visit is crucial.

Purpose of the Study:

• To determine the frequency of serious abusive injury within 12 months after an ED encounter for a sentinel injury in children aged 0-24 months.
• To analyze the rate of subsequent serious abusive injury in children initially diagnosed with abuse during the sentinel injury ED visit.

Main Methods:

• Utilized the Healthcare Cost and Utilization Project State ED and Inpatient Databases (2014-2019).
• Identified children aged 0-24 months with an ED diagnosis of a sentinel injury.
• Defined the primary outcome as serious abusive injury (admission for serious injury or death with a child abuse diagnosis) within 12 months.

Main Results:

• A total of 23,919 children with sentinel injuries were analyzed (median age 5 months).
• Serious abusive injury was diagnosed in 0.7% of patients within 12 months of the sentinel injury ED visit.
• Of the 4.8% of children diagnosed with abuse at the index visit, 8.3% experienced a subsequent serious abusive injury.

Conclusions:

• The diagnosis of serious abusive injury is infrequent after an initial ED sentinel injury diagnosis.
• The majority of abuse diagnoses occurred at the sentinel injury ED visit.
• A notable proportion of children diagnosed with abuse at the initial visit are at risk for subsequent serious injury, warranting further risk stratification.