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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Emergency department overcrowding and child physical abuse evaluations at a tertiary pediatric hospital
H Michelle Greene1, Sara Helwig2, Becca Fredin3
1Division of Emergency Medicine, Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Division of Child Abuse Pediatrics, Nationwide Children's Hospital, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Emergency department overcrowding is linked to fewer identified child abuse cases. Standardizing evaluations may help detect abuse during busy periods.
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse Recognition
- Healthcare Management
Background:
- Emergency Department (ED) overcrowding can compromise patient care quality.
- Limited time in overcrowded EDs may hinder the identification of child physical abuse.
- Pediatric patients with abusive injuries might be underdiagnosed in busy ED settings.
Purpose of the Study:
- To investigate the correlation between Emergency Department overcrowding and the identification of child abuse concerns.
- To analyze how ED crowding metrics impact the reporting and consultation rates for suspected child abuse.
Main Methods:
- Retrospective chart review of pediatric ED encounters from January 1, 2019, to June 30, 2023.
- Comparison of ED overcrowding metrics (mNEDOCS, length of stay, LWBS rates, patient volumes) with rates of Child Protective Services (CPS) reports, skeletal surveys (SS), and child protection team (CPT) consults for children under 18.
- Analysis included 310,512 ED encounters.
Main Results:
- Increased ED overcrowding showed a negative correlation with the proportion of ED visits involving CPS reports, SS, and CPT consults (rho -0.1 to -0.21, p > 0.001).
- No significant differences in patient age or disposition were observed between the highest and lowest overcrowding quartiles.
- The COVID-19 period exhibited lower ED volumes but a higher proportion of visits with child abuse concerns.
Conclusions:
- Higher ED crowding is associated with a reduced proportion of identified child abuse cases, suggesting potential underdiagnosis during peak times.
- Standardizing physical abuse evaluations in the ED is recommended to mitigate variability and improve detection during periods of overcrowding.
- This highlights the need for systemic improvements to ensure child abuse is not missed during high-volume ED periods.
Background:
Overcrowding in the Emergency Department (ED) can result in lower care quality. Lack of time can be a barrier to recognition of child physical abuse. Pediatric patients with abusive injuries may not be identified as frequently in an overcrowded ED.
Objective:
This study sought to evaluate correlation of ED overcrowding and child abuse concerns.
Participants And Setting:
This is a retrospective chart review for tertiary pediatric ED encounters between January 1, 2019, and June 30, 2023.
Methods:
Analyses compare ED overcrowding metrics, including the modified National Emergency Department Overcrowding Score (mNEDOCS), length of stay, rates of patients who left without being seen, and patient volumes, with the proportion of ED visits in children <18 years with Child Protective Services (CPS) reports for physical abuse, skeletal surveys (SS), or child protection team (CPT) consults.
Results:
Increasing ED overcrowding for 310,512 ED encounters were negatively correlated with the proportion of ED visits with CPS reports, SS, and inpatient CPT consults, with rho ranging from -0.1 to -0.21, all p > 0.001. There was no difference in ages or dispositions of patients with abuse concerns during days in the highest and lowest quartiles of mNEDOCS. The COVID-19 timeframe had lower ED volumes but higher proportion of visits with child abuse concerns.
Conclusions:
More crowding in the ED was associated with a lower proportion of ED visits with CPS reports, SS, or completed CPT consults, indicating potential missed abuse during busy times. Efforts to standardize physical abuse evaluations may reduce variability during overcrowding.
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