Epidemiology of pediatric abuse- and neglect-associated emergency department visits in the United States: an analysis of the 2019-2022 National Hospital Ambulatory Medical Care Survey.

Abstract

Context: Child maltreatment impacts an estimated 7.4 per 1,000 children in the United States. Given the severity of some abusive injuries, children may present to emergency departments (EDs). As such, EDs are primary screening locations for early identification of maltreatment.

Objectives: Our objective was to assess rates of maltreatment among pediatric patients presenting to the ED.

Methods: We performed a cross-sectional analysis of pediatric ED visits utilizing data from the Center for Disease Control's (CDC) National Hospital Ambulatory Medical Care Survey (NHAMCS, 2019-2022). Child maltreatment was identified by International Classification of Diseases (ICD) diagnosis codes of confirmed and suspected maltreatment, examinations performed after sexual assault, problems related to upbringing, malnutrition, and chief complaint codes for 'child abuse,' 'sexual abuse,' or 'rape.' Design-based chi-squared tests and regression models were utilized to determine associations between sociodemographic factors, comorbidities, wait time, and length of stay for these patients.

Results: Our sample included 13,896 pediatric visits. After applying sampling weights, 1.4 % of pediatric ED visits (422,755 visits annually) were related to maltreatment. Of these visits, 62.7 % were for examinations after sexual assault, 31.2 % included maltreatment, and 6.1 % were for problems related to upbringing or malnourishment. No significant associations were observed by race, age, insurance, sex, or rurality. When evaluating associations between comorbidities and child maltreatment-related visits, associations of asthma, substance use, and developmental disorders were statistically significant (p<0.05). Additionally, visits for these encounters were 28.0 minutes longer compared to other visits (p=0.040).

Conclusions: Our findings show maltreatment-affected children across sociodemographics between 2019 and 2022, with more than 420,000 cases presenting to the ED annually. Our results showed that higher rates of maltreatment were found among children with substance use and developmental disorders. At the hospital level, maltreatment visits were often longer than usual visits, but with shorter boarded time - more arriving via ambulance compared to other visits. This underscores the urgent need for comprehensive education and training for all ED staff on how to recognize and respond to child maltreatment across diverse populations. Taking a comprehensive history as well as implementing evidence-based protocols can help increase sensitivity to child maltreatment in EDs across the United States.