Factors Associated With Child Protective Services Referrals in Young Children With Isolated Skull Fractures

Area of Science:

• Pediatric Traumatology
• Child Abuse Pediatrics
• Forensic Pediatrics

Background:

• Young children with isolated skull fractures are often referred to child protective services (CPS).
• These referrals occur despite assessments indicating a low likelihood of abuse.
• Significant variation exists in CPS referral practices across different hospitals.

Purpose of the Study:

• Identify factors associated with CPS referrals in young children with isolated skull fractures.
• Quantify hospital-level variation in CPS referral rates.
• Inform guidelines for appropriate CPS referrals in cases of pediatric skull fractures.

Main Methods:

• Multicenter retrospective cross-sectional study of children under 2 years with skull fractures.
• Included children with or without intracranial hemorrhage (ICH) and no other injuries, who underwent a child abuse pediatrics (CAP) evaluation.
• Used multivariable logistic regression and marginal standardization to analyze CPS referral factors and hospital variation.

Main Results:

• Over half (57.4%) of 528 children were referred to CPS, most before CAP consultation (86.5%).
• Factors associated with CPS referral included psychosocial risk factors, in-person CAP consult, inflicted/no trauma history, absence of ICH, and hospital site.
• Adjusted CPS referral rates varied significantly across hospitals, ranging from 34.6% to 76.4%.

Conclusions:

• A two-fold variation in CPS referrals for pediatric skull fractures exists based on hospital site.
• The majority of CPS referrals occur before specialist child abuse pediatrics consultation.
• Findings highlight the need for standardized guidance on indications for CPS referral in these cases.