van Bockxmeer John, Enzor Lesley, Makate Marshall, Robinson Suzanne
Emergency Department, WA Country Health Service, Perth, Western Australia, Australia.
Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.
Emerg Med Australas. 2025 Feb;37(1):e70000. doi: 10.1111/1742-6723.70000.
Children with non-accidental injuries have increased risk of future death. There is insufficient evidence for widespread physical abuse screening tool use in the ED. This study assesses the utility of a physical abuse project that includes the implementation of a screening tool with case-matching from multiple sources. It aims to confirm whether risk-screening in a medium-sized rural Australian ED is reliable and will improve outcomes.
This is a 16-month ED retrospective pre-/post-implementation study of all injury, burn or poisoning cases 16 years and under during a paediatric physical abuse safety project which included a screening tool. Presentations with potential physical abuse were filtered by ICD-10 codes and reviewed. Multivariable logistic regression models compared pre- and post-implementation cases. Analyses examined outcomes, trends and interrogated the screening tool which formed a Clinical Pathway Algorithm (CPA).
A total of 1469 presentations underwent investigation: 747 pre-implementation and 722 post-implementation. Pearson's χ test showed statistically insignificant differences. If tool used, documentation improved (odds ratio [OR] 7.73; 95% confidence interval [CI] 4.91-12.18), child protection service referrals increased (OR 5.50; 95% CI 1.82-16.61) and hospital admissions decreased (OR 0.42; 95% CI 0.22-0.79). Re-presentation rates stayed the same. Increased physical abuse was associated with screening factors including carer behavioural concerns, inadequate supervision, delayed presentation, repeat and unexplained injuries (ORs/CIs in an accompanying Table 4). Screening tool sensitivity was 62.3% and specificity 79.7%.
Implementing this ED paediatric physical abuse project improved safety behaviours and best-practice documentation. The tool improved medical decision making without increased re-presentations. ED clinicians may use similar CPAs to help review safety concerns and facilitate discharge; however, resources are needed to investigate referrals flagged due to false-positive rates.
遭受非意外伤害的儿童未来死亡风险会增加。目前尚无足够证据支持在急诊科广泛使用身体虐待筛查工具。本研究评估了一个身体虐待项目的效用，该项目包括实施一种筛查工具，并从多个来源进行病例匹配。其目的是确认在澳大利亚一个中等规模的农村急诊科进行风险筛查是否可靠，以及能否改善结果。
这是一项为期16个月的急诊科回顾性实施前/后研究，研究对象为在一个包括筛查工具的儿科身体虐待安全项目期间16岁及以下的所有受伤、烧伤或中毒病例。通过国际疾病分类第十版（ICD - 10）编码筛选出可能存在身体虐待的病例并进行审查。多变量逻辑回归模型对实施前和实施后的病例进行了比较。分析考察了结果、趋势，并对构成临床路径算法（CPA） 的筛查工具进行了研究。
共对1469例就诊病例进行了调查：实施前747例，实施后722例。Pearson卡方检验显示差异无统计学意义。若使用该工具，记录情况有所改善（优势比[OR] 7.73；95%置信区间[CI] 4.91 - 12.18），儿童保护服务转诊增加（OR 5.50；95% CI 1.82 - 16.61），住院人数减少（OR 0.42；95% CI 0.22 - 0.79）。再次就诊率保持不变。身体虐待增加与一些筛查因素相关，包括照顾者行为问题、监管不足、就诊延迟、反复及不明原因的损伤（相关表4中的ORs/CIs）。筛查工具的敏感性为62.3%，特异性为79.7%。
实施该急诊科儿科身体虐待项目改善了安全行为和最佳实践记录。该工具改善了医疗决策，且未增加再次就诊率。急诊科临床医生可使用类似的临床路径算法来帮助审查安全问题并促进出院；然而，由于假阳性率，需要资源来调查标记出的转诊病例。
