Child maltreatment in U.S. emergency departments: Imaging and admissions |
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| Institution: | 1. Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA;2. Center for Injury Research and Policy, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA;3. The Ohio State University College of Medicine, 370 West 9th Avenue, Columbus, OH, USA;4. Trauma Program, Nationwide Children’s Hospital, Columbus, OH, USA;1. Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States;2. Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States;3. PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States;4. Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, United States;1. Université Laval, École de Psychologie, pavillion Félix-Antoine-Savard, 2325, rue des Bibliothèques, Québec, (Québec), G1V 0A6 Canada;2. Université du Québec à Trois-Rivières, 3351 boul. des Forges, C.P. 500, Trois-Rivières (Québec), G9A 5H7 Canada |
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| Abstract: | ObjectiveWe report imaging and admission ratios for children with definitive and suggestive maltreatment in a national sample of emergency departments (EDs).MethodsUsing the 2012 Nationwide Emergency Department Sample (NEDS), we generated national estimates of ED visits for children <10 years with both definitive and suggestive maltreatment. Outcomes were admission/transfer ratios for children <10 years and screening ratios by skeletal surveys and head computed tomography (CT) for children <2 years with suspected physical abuse. We compared hospitals with low, medium, and high pediatric ED volumes using multivariable logistic regression.ResultsThe 2012 national estimate of U.S. ED visits (children <10 years) with definitive maltreatment is 14,457 (95% CI: 11,987–16,928). Suggestive child maltreatment was seen in an additional 103,392 (95% CI: 90,803–115,981) pediatric ED visits. After controlling for patient case mix, high volume hospitals had a significantly higher adjusted odds ratio (AOR) of admission/transfer among definitive cases (AOR = 1.74, 95% CI: 1.08–2.81), and medium volume hospitals had a higher odds of admission/transfer among suggestive cases (AOR = 1.24, 95% CI: 1.02–1.50) when compared with low volume hospitals. In hospitals with reliable reporting of imaging procedures, high volume hospitals reported skeletal surveys (age <2 years) significantly more often than low volume hospitals, AOR = 3.32 (95% CI: 1.25–8.84); the AORs for head CT did not differ by hospital volume.ConclusionsLow volume hospitals were less likely to screen by skeletal survey, but head CT ratios were not affected by ED volume. Low volume hospitals were also less likely to admit or transfer. |
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| Keywords: | Child abuse and neglect Trauma |
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