Evaluation of drug-endangered children: The yield of toxicology and skeletal survey screening.

BACKGROUND

Drug endangerment is known to be associated with child maltreatment. However, even with the high association between physical abuse and drug endangerment there is no standard for screening in this population. Skeletal survey screening may facilitate the identification of children in this population who have also been physically abused.

OBJECTIVE

Our objective was to determine the characteristics of drug endangered children and specifically the yield of skeletal survey screening.

PARTICIPANTS AND SETTING

The participants in this study were children referred by Child Protective Services (CPS) due to concerns of drug exposure. They were seen in a child abuse outpatient clinic by a child abuse pediatrician or pediatric nurse practitioner.

METHODS

This study is a retrospective chart review of the Child Advocacy Resource and Evaluation (C.A.R.E.) Team records between January 1, 2011 and December 31, 2017. We measured the yield of toxicology, additional abuse endured, and skeletal survey findings.

RESULTS

Over the 6-year period, 1252 cases were referred to C.A.R.E. Team for drug endangerment. 1150 cases had hair toxicology performed with 595 cases (52%) testing positive for at least one illegal substance. The compound most frequently identified was methamphetamine followed by marijuana and cocaine. In addition to drug endangerment, other forms of abuse were identified in 162 cases including sexual, physical, and neglect. Using the American Academy of Pediatrics (AAP) and American College of Radiology (ACR) guidelines, 340 skeletal surveys were performed. Twelve cases (4%) had occult skeletal injuries none of which had cutaneous findings. Of those with skeletal injury, 11 cases out of 11 tested by hair toxicology were positive for at least one illegal substance.

CONCLUSIONS

The application of the AAP and ACR guidelines for skeletal survey screening to those children referred for drug endangerment is useful in identifying children with physical abuse.