722 - Variation in Evaluation of Suspected Physical Child Abuse Across Pediatric Emergency Departments

Publication Number: 3699.722

Hannah Forte, University of Michigan Medical School, Ann Arbor, MI, United States; Wendi Wendt, Medical College of Wisconsin, Milwaukee, WI, United States; James A.. Cranford, University of Michigan, Ann Arbor, MI, United States; Danny Thomas, Medical College of Wisconsin, Brookfield, WI, United States; Julie Leonard, Nationwide Children's Hospital, Columbus, OH, United States; H Michelle Greene, Nationwide Children's Hospital, Columbus, OH, United States; Nidhi Singh, Baylor College of Medicine, Houston, TX, United States

Background: Despite national recommendations for the evaluation of suspected physical child abuse, substantial variability likely exists across pediatric emergency departments (EDs). Understanding these differences is crucial to improving diagnostic accuracy and equity in child abuse evaluations. This study aimed to describe current institutional practices, guidelines, and resources related to the evaluation and management of suspected child abuse across the Pediatric Emergency Care Applied Research Network (PECARN).

Objective: To describe current institutional practices, guidelines, and resources related to the evaluation and management of suspected child abuse across the Pediatric Emergency Care Applied Research Network (PECARN).

Design/Methods: A survey developed by the Child Abuse Research Group of PECARN was distributed to all 18 PECARN institutions. The PECARN Nodal PI from each hospital completed the survey. Responses were analyzed to identify variations across practice domains in the evaluation and management of physical child abuse, including screening, imaging, reporting, and resource availability.

Results: All PECARN institutions responded. 78% had an electronic medical record (EMR) orderset for physical abuse evaluation, but only 67% reported having institutional guidelines. Half used EMR-generated prompts or internal guidelines to screen for sentinel injuries. Practices surrounding law enforcement notification, domestic violence exposure, and safety admissions varied. Screening for occult abdominal injury was common (78%), but thresholds for AST/ALT and lipase elevation, urinalysis findings, and age cutoffs differed across hospitals. Head imaging practices differed with some hospitals using CT exclusively, others MRI or fast brain imaging. Repeat skeletal surveys were performed at 10-14 days by 72% of hospitals. All hospitals reported access to a child abuse pediatrics team, but the extent of in-person availability, clinic follow-up, and after-hours coverage differed.

Conclusion(s): Despite near-universal presence of child abuse teams and ordersets, wide variation persists in evaluation practices, reporting, and workflows across PECARN EDs. These inconsistencies highlight future opportunities for more research to determine whether standardized, evidence-based approaches improve diagnostic accuracy, equity, and outcomes in suspected child maltreatment.

Table 1
Table 1.pdfDomains with notable practice variability in the evaluation and management of children presenting with concern for physical abuse.