Related Experiment Video
Updated: Jan 9, 2026
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Factors Associated With Child Protective Services Referrals in Young Children With Isolated Skull Fractures
Karli Breeden-Carino1, Joanne N Wood2, Cindy W Christian3
1Division of General Pediatrics (K Breeden-Carino), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
Insights
Many young children with skull fractures are referred to child protective services (CPS), even with low abuse likelihood. Factors like psychosocial risks and hospital site influence CPS referrals, showing significant variation across institutions.
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.
Objective:
Many young children with isolated skull fractures are referred to child protective services (CPS) despite being assessed to have a low likelihood of abuse. We sought to identify factors associated with CPS referrals in this population and to quantify hospital-level variation.
Methods:
We performed a multicenter retrospective cross-sectional study of children <2 years with skull fractures with or without a small underlying intracranial hemorrhage (ICH) and no additional injuries undergoing a child abuse pediatrics (CAP) subspecialty evaluation. We explored associations between demographic factors, clinical characteristics, psychosocial risk factors, and hospital site with CPS referral status. We performed multivariable logistic regression, adjusting for transfer status and all significant covariates from unadjusted analyses. We utilized marginal standardization to calculate the estimated probability of CPS referrals at each site, adjusting for all factors in the final model.
Results:
Of 528 children, 303 (57.4%) were referred to CPS, with 86.5% referred before CAP consultation. In multivariable logistic regression, presence of psychosocial risk factors (OR 4.00; 95% CI 2.25, 7.11), in-person CAP consult (OR 3.93; 1.61, 9.62), inflicted or no trauma history provided (OR 6.15; 3.30, 11.45), absence of ICH (OR 2.03; 1.26, 3.27), and site were significantly associated with CPS referral. After adjustment for case-mix, the percentage of children referred to CPS ranged from 34.6% to 76.4% across sites.
Conclusions:
We found a twofold variation in CPS referrals based on site. Most referrals occurred before CAP involvement. These findings support the need for increased guidance regarding indications for referral.
More Related Videos
10:31A Multi-Modal Approach to Assessing Recovery in Youth Athletes Following Concussion
Published on: September 25, 2014
07:02An Investigation of the Effects of Sports-related Concussion in Youth Using Functional Magnetic Resonance Imaging and the Head Impact Telemetry System
Published on: January 12, 2011
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:29Psychological and Sociocultural Causes of Schizophrenia