Elsevier

The Journal of Pediatrics

Volume 154, Issue 2, February 2009, Pages 272-277.e1
The Journal of Pediatrics

Original article
Prediction of Child Abuse Risk from Emergency Department Use

Presented in part at the national Pediatric Academic Societies/American Academy of Pediatrics meeting in Washington, DC, May 2005.
https://doi.org/10.1016/j.jpeds.2008.07.047Get rights and content

Objective

To examine whether pre-abuse rates and patterns of emergency department (ED) visits between children with supported child abuse and age-matched control subjects are useful markers for abuse risk.

Study design

A population-based case-control study using probabilistic linkage of four statewide data sets. Cases were abused children <13 years of age, identified between January 1, 2002, and December 31, 2002. For each case, a birth date–matched, population-based control was obtained. Outcome measures were rate ratios of ED visits in cases compared with control subjects.

Results

Cases (n = 9795) and control subjects (n = 9795) met inclusion criteria; 4574 cases (47%) had an ED visit; thus linked to the ED database versus 2647 control subjects (27%). The crude ED visit rate per 10 000 person-days of exposure was 8.2 visits for cases compared with 3.9 visits for control subjects. Cases were almost twice as likely as control subjects (adjusted rate ratio = 1.8; 95% CI, 1.5, 1.8) to have had a prior ED visit. Leading ED discharge diagnoses were similar for both groups.

Conclusions

Children with supported child abuse have higher ED use before abuse diagnosis, when compared with the general pediatric population. However, neither the rate of ED use nor the pattern of diagnoses offers sufficient specificity to be useful markers of risk for abuse.

Section snippets

Methods

This population-based case-control study compares ED utilization patterns between Utah-born children with a supported Division of Child and Family Services (DCFS) child abuse report for whom the initial disclosure of abuse occurred between January 1, 2001, and December 31, 2002, and age-matched control subjects. This study was approved by the University of Utah Institutional Review Board and Division of Child and Family Services Institutional Review Board. A Waiver of Informed Consent was

Cases

There were 19 005 children in the state of Utah with supported abuse during the study period. Of these, 52% (n = 9795) met study inclusion criteria. Of those children who were excluded, 46% (n = 4459) were due to age ≥13 years, 40% (n = 3888) for not having a Utah birth record, and 9% (n = 863) for ineligible abuse type.

The majority (79%) of the cases were white, reflecting the general population of Utah (89.2% white),18 58% (n = 5718) had a parent with a valid Utah driver license during the

Discussion

This study has 3 major findings. First, most children with supported abuse are not seen in the ED before the diagnosis of abuse. Specifically, although there is a two times greater number of visits in cases than in control subjects, this only changes the visit rate from a median of 1 to 2 visits before the diagnosis of abuse. In addition, this difference in ED visits decreases even further when stratified by insurance status. Second, most visits occur 1 month or more before the finding of

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    Supported by a National Institutes of Child Health and Human Development (NICHD) grant for Dr. Guenther (K23HD043145). Partial support for all datasets within the Utah Population Database is being provided by the Huntsman Cancer Institute.

    The authors declare no potential conflicts of interest.

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