Child Welfare
Variation in Occult Injury Screening Across Pediatric Hospitals
Research Lead: Joanne N. Wood, MD MSHP
Study Team: David M Rubin, MD MSCE
Sponsored By: PolicyLab
Dates: Ongoing
Background
Infants presenting to pediatric hospitals with serious injuries are frequently victims of child abuse and may have occult injuries from abuse. Previous research has identified infants at high risk for abuse and has led to recommendations for screening high risk infants for occult abusive injuries. However, little information is known about the quality of child abuse evaluations and rates of adherence to occult injury screenings recommendations at pediatric hospitals. Earlier studies suggest that the rates of occult injury screening may vary based on demographic characteristics of the child and on characteristics of the hospital.
Aims
To identify variations in occult injury screening across pediatric hospitals for:
- Children less than 1 year of age with high risk injuries for abuse
- Children less than 2 years of age with a diagnosis of physical abuse
To identify rates of occult injury screening practices based on the structural quality of the hospital child abuse team.
Methods
Study Design: A retrospective study of infants presenting to 40 pediatric hospitals with femur fractures or traumatic brain injury (TBI) was conducted. Using the Pediatric Health Information System (PHIS) Database, data were collected for years 1999-2009. Data on type of hospital child abuse team were collected from the National Association of Children's Hospitals and Related Institutions (NACHRI) 2005 survey on Children’s Hospital Child Abuse Services.
Population:
- 12,983 eligible high risk infants less than 1 year of age with TBI or femur fracture
- 10,096 children less than than 2 years of age with a diagnosis of physical abuse
Progress
Data collection was completed in 2010. Data analysis and publication are pending.
Policy Focus
Determining hospital variation in occult injury screening practices can inform initiatives that aim to monitor and promote adherence to screening guidelines. Screening practices must be examined to develop a collective response to evaluation and care of high risk and abused children.
Dissemination
Wood J, Rubin, D. Variation in occult injury screening practices across pediatric hospitals. Platform presentation at Helfer Society Annual Meeting, Amelia Island, Florida, April 2011.
Relevant Resources
2005 Survey Findings: Children’s Hospitals Child Abuse Services NACHRI; 2006.
AAP. Diagnostic imaging of child abuse. Pediatrics 2000;105(6):1345-8.
Jenny C; American Academy of Pediatrics, Committee on Child Abuse and Neglect. Evaluating infants and young children with multiple fractures. Pediatrics. 2006;118:1299-1303.
Kellogg ND. Evaluation of suspected child physical abuse. Pediatrics. 2007;119(6):1232-1241.
National Association of Children's Hospitals and Related Institutions
