Evaluation of a Child Abuse Screen Performed by Nurses Among Young Children with Fractures Seen in a Pediatric Emergency Department.

AIMS

To assess institutional compliance with, and test characteristics of, a child abuse screen performed by emergency department (ED) nurses for children <5 years old who were diagnosed with fractures.

METHODS

A secondary analysis of a retrospective observational study of children 0-5 years old with fractures seen at a pediatric ED between January 2018 and April 2023 was performed. We analyzed demographics, ED visit data, and results of the nurse-completed abuse screen. Screen results were compared to ED clinician concern for abuse to calculate test characteristics.

RESULTS

The mean age of the 2,705 children identified was 38.4 months (SD 19.8). Out of the total patient cohort, 2,449 (90.5%) had a nurse-completed screen. Among these, 65 patients (2.4%) screened positive for possible abuse. We found no statistically significant difference in screen completion by age group, race, ethnicity, language, or insurance type. Of 312 (11.5%) encounters with clinician concern for abuse, 17.6% screened positive, 76.0% screened negative, and 6.4% had an incomplete screen. The sensitivity and specificity among screened children aged 0-5 were 19.2% [95% CI 14.7-23.8%] and 99.5% [95% CI 99.3-99.8%]. The PPV and NPV were 84.6% [95% CI 75.8-93.4%] and 90.3% [95% CI 89.1-91.5%]. Comparatively, among children <12 months, the sensitivity was 24.4% [95% CI 18.0-30.8%], specificity was 98.1% [95% CI 95.4-100%], PPV was 95.5% [95% CI 89.3-100%], and NPV was 43.7% [95% CI 37.3-50.1%].

CONCLUSIONS

Although there was high compliance with this nurse-completed abuse screen, it is an inadequate sole modality for screening young children with fractures, with a low probability of a positive screen given clinician concern for potential abuse for the entire cohort and among high-risk infants.