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Referrals to Child Protective Services for pediatric emergency department patients after falls
Joseph P Shapiro1, Elizabeth C Pino2, Ayesha Dholakia3
1Division of Emergency Medicine and Trauma, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC, 20010, United States of America.
Insights
Child Protective Services (CPS) referrals for unintentional falls in children are linked to injury severity and fall height, not race. These factors may indicate inadequate supervision or simply reflect the seriousness of the fall-related injury.
Area of Science:
- Pediatric Emergency Medicine
- Child Injury Prevention
- Child Welfare
Background:
- Falls are the primary cause of non-fatal injuries in US children.
- Clinicians may involve Child Protective Services (CPS) when falls suggest inadequate supervision.
- Data on CPS referral frequency and decision factors for unintentional falls are lacking.
Purpose of the Study:
- To examine characteristics of children presenting to a pediatric emergency department (PED) for unintentional falls.
- To determine the relationship between patient race and CPS referrals for suspected supervisory neglect.
Main Methods:
- Cross-sectional analysis of 933 children under 5 years old treated for unintentional falls in an urban academic PED (Oct 2015-Dec 2020).
- Data extracted from electronic health records and manual chart review included demographics, fall details, injuries, and CPS referrals.
- Logistic regression models assessed associations between patient/visit characteristics and CPS referral.
Main Results:
- 2.4% of eligible encounters (22 patients) resulted in a CPS referral.
- Higher fall height (>1m), fracture diagnosis, head injury diagnosis, and ambulance arrival were associated with increased odds of CPS referral.
- Patient race was not significantly associated with CPS referral rates.
Conclusions:
- CPS referrals following unintentional pediatric falls are primarily associated with injury severity and fall height.
- Further research is needed to differentiate between inadequate supervision and injury severity as drivers of CPS referrals.
Background:
Falls are the leading cause of non-fatal childhood injury in the United States. When falls are thought to result from inadequate supervision, clinicians may refer families to Child Protective Services (CPS). However, the frequency of CPS referrals for unintentional falls and factors influencing referral decisions are unknown.
Objective:
To investigate characteristics of children presenting to the pediatric emergency department (PED) for unintentional falls and the relationship between patient race and referrals to CPS for supervisory neglect.
Participants And Setting:
Children under 5 years old evaluated at an urban academic PED for an unintentional fall between October 2015 and December 2020.
Methods:
We conducted a cross-sectional analysis using electronic health record diagnosis codes to identify patients. Patient demographics, fall characteristics, injuries, ED arrival method, and CPS referrals were abstracted by manual chart review. Logistic regression models evaluated associations between patient demographics and visit characteristics with CPS referral.
Results:
Among 933 eligible encounters, 22 patients (2.4%) were referred to CPS. In univariate analysis, fall height > 1 m (OR = 8.77, 95% CI 3.61-21.29, p = 0.0001), fracture diagnosis (OR = 5.15, 95% CI 2.15-12.33, p = 0.003), head injury diagnosis (OR = 4.34, 95% CI 1.75-10.76, p = 0.02), and ambulance arrival (OR = 3.57, 95% CI 1.50-8.50, p = 0.05) were associated with higher odds of CPS referral. Race was not significantly associated with referral.
Conclusions:
CPS referrals after unintentional falls are associated with injury severity and fall height rather than race. Future research should examine whether these factors reflect inadequate supervision or simply injury severity.
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