Medical News: Domestic Violence
Multiple ED Visits for Kids May Signal Neglect
By Kristina Fiore, Staff Writer, MedPage Today
Published: February 26, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine. Earn CME/CE credit
for reading medical news
COLUMBIA, Mo., Feb. 26 — Children brought to the emergency
department
with frequent injuries are likely candidates for reports to child
protective services, researchers here said. Action Points
——————————————————————————–
Explain to interested patients that children with two or more injury-
related medical visits in a year were twice as likely to have a child
maltreatment report filed with child protection agencies than those
with only one visit.
Note that the number of filed reports and substantiated reports rose
with the number of injuries per year.
Kids with two or more injury-related medical visits within a year
were
more likely to have been reported for child maltreatment and have
substantiated reports than those with only one visit, Patricia G.
Schnitzer, Ph.D., of the University of Missouri, and colleagues
reported online in the Journal of Emergency Medicine.
Neglect — including inadequate supervision — is the most common
type
of child maltreatment, the researchers said. "Many more injuries are
related to neglect than to inflicted injury," they said, although
such
issues are not commonly documented in the ED record.
Also, no studies have documented a relationship between the number of
injury-related medical visits and reports from child protection
agencies.
So to assess the relationship, the researchers looked at emergency
department data on 50,068 children under age 5 with 56,364 injury
visits from Jan. 1, 2000 to Dec. 31, 2000. The average age was 2 and
61% were younger than 3.
They also analyzed data from the Missouri Child Protective Services
on
reports of child abuse and neglect.
The researchers found that children with two injury-related visits in
a year were nearly twice as likely as children with only one visit to
have a maltreatment report filed with the state’s Child Protective
Services (RR 1.9, 95% CI 1.8 to 2.0).
Also, as the number of visits increased, the relative risk of a
report
increased, as did the likelihood of the report being substantiated.
Children with four or more visits had a nearly four-fold increased
risk of a report (RR 3.8, 95% CI 3.0 to 4.7) and a five-fold
increased
risk of a substantiated report (RR 4.7, 95% CI 2.4 to 9.2).
Those with two visits had a 2.5-fold increased risk of having a
substantiated report (95% CI 2.1 to 2.9).
Infants under a year old were significantly more likely than older
children to have a child services report filed (RR 1.34, 95% CI 1.26
to 1.44) and to have had that report substantiated (RR 1.74, 95% CI
1.47 to 2.05).
The most common causes for the presenting injuries were falls and
being struck by or against something, the researchers said.
"Once an inflicted injury has been ruled out, we suggest that
emergency department physicians treating children with a history of
multiple injury visits consider the possibility of neglect or lack of
supervision an etiology," the researchers said.
They did acknowledge, however, that the availability of historical
information is sometimes lacking in emergency departments. But Dr.
Schnitzer said that the implementation of electronic medical records
and other technologies will make it easier for physicians to identify
children at risk for further neglect.
Some of the study’s limitations included the fact that children could
not be followed beyond one year, and that data were limited to basic
demographic variables and injury codes.
Also, the researchers noted, it shouldn’t be interpreted that injured
children without Child Protective Services reports were not
maltreated.
The study was supported by a contract for epidemiologic support and
analysis of Missouri’s nonfatal child maltreatment surveillance data.
The researchers reported no conflicts of interest.
Primary source: Journal of Emergency Medicine
Source reference:
Spivey MI, et al "Association of injury visits in children and child
maltreatment reports" J Emergency Med 2009; DOI: 10.1016/j.jemermed.
2007.07.025.
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