Prior Emergency Department Utilization Association With Nonaccidental Trauma in Children

Abstract

Introduction

Physical child abuse (PCA) is believed to occur in an escalating manner with multiple episodes occurring over time. This pattern may potentially lead to multiple emergency department (ED) visits, often to different EDs. The aim of this study was to evaluate prior ED utilization as a risk factor for PCA in children.

Materials and methods

A retrospective case-control study was conducted of children evaluated for potential PCA at a level I pediatric trauma center. Cases included patients deemed probable PCA by the hospital forensic team. Demographic data of cases was transferred to the Center for Health Information and Research for statewide matching with accidental injury controls based on age and time of injury. Additional information on all prior ED visits (for any reason) in the state within 4 y was extracted for all cases and controls. Logistic regression assessed the relationship of prior ED utilization with PCA for patients with ≥1 prior ED visits.

Results

Of the total 518 patients identified, only 303 (58%) had at least one prior ED visit and were analyzed. PCA cases versus accidental injury controls were more likely to be younger (1.5 ± 1.8 versus 1.9 ± 2.0 y, P = 0.04), have Medicaid (86% versus 72%, P = 0.01), and ≥2 prior ED visits (62% versus 48%, odds ratio 1.76 [1.11-2.8] P = 0.02). On multivariable logistic regression controlling for patient age, race, and payer status, each additional prior ED visit increased the odds of PCA by 19% (adjusted odds ratio 1.19 [1.03 – 1.39], P = 0.02).

Conclusions

Frequency of prior ED utilization is an independent risk factor for PCA. Each prior ED utilization increases a patient's odds for child abuse by 19%. A history of multiple prior ED may be used to help predict nonaccidental trauma.