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Identification and Evaluation of Abuse in a Pediatric Emergency Department: Use of a Screening Tool to Increase Involvement of the Child Protection Team in Early Detection

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Identification and Evaluation of Abuse in a Pediatric Emergency Department: Use of a Screening Tool to Increase Involvement of the Child Protection Team in Early Detection
Emily Powers, MD, Gunjan Tiyyagura, MD, Rebecca Moles, MD, Emily Christison-Lagay, MD, Shaina Goldsmith, MD and Marc Auerbach, MD, Yale University School of Medicine, New Haven CT

Objective: Introduction: Child physical abuse is common. ED personnel may be the first or only medical contact for abuse victims to be recognized. Existing ED child abuse screening tools decrease bias and increase resource utilization but do yet demonstrate increased detection of abuse. We hypothesized that a novel screening tool incorporating Child Protection Team (CPT) consult for specific injuries in children less than one year of age would increase CPT utilization, decrease bias, and increase detection of abuse.
Methods: A screening tool was implemented in the ED on 4/1/2014. Data were collected 3 months before and after implementation. All Infants ? 12 months presenting to ED with an injury specified by the tool were included. Demographics, diagnostic studies, CPT consults, and ultimate determination of abuse by CPT were collected on each subject.
Results: There was a significant increase in the use of CPT and SW after implementation of the tool. Preliminary results indicate a potential decrease in racial and economic bias in involvement of CPT. There was a significant increase in diagnostic testing but not in detection of abusive injury. Discussion: This is the first screening tool to focus on early involvement of CPT to increase detection of abusive injury. While this study was not powered to detect an increase in abusive injury identification, the tool successfully increased involvement of CPT. Because involvement of CPTs is known to increase detection of abuse, this approach may yield increased detection rates if studied over a longer time period.
Objective: Identify injuries concerning for child abuse in infants less than one and explain the use of Child Protection teams in identifying abusive injury.Objective Content: At the end of this activity, the learner will be able to explain why CPTs were utilized in this study as part of a screening tool.


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