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How Hospitals Can Improve Child Abuse Detection, Address Disparities

CHOP’s PolicyLab brief identifies opportunities within and between hospital settings

March 18, 2022

A new report from the Children's Hospital of Philadelphia (CHOP) PolicyLab provides critical insights on detecting child abuse and the need to address disparities in screening in hospital settings.

The PolicyLab’s Spring 2022 Evidence to Action brief reviews U.S. pediatric and general hospital data and the use of skeletal surveys to detect occult (hidden) fractures. The American Academy of Pediatrics recommends providers perform a skeletal survey to identify hidden fractures in all children under 2 with injuries that raise concerns for physical abuse.

The researchers found uneven use and disparities around when these skeletal surveys are used to evaluate for additional occult injuries among young injured children.

“Accurate, timely diagnosis of physical abuse is key to preventing repeated and escalating abuse,” the brief notes. “However, nearly 1 in 3 young children diagnosed with an abusive injury had previous primary care, emergency department, or specialty care visits during which there was a missed opportunity to diagnose abuse and intervene to protect the child from further harm.”

Among the key research takeaways:

  • There are significant race and socioeconomic status-based disparities in screening for child abuse at pediatric hospitals
  • There is significant variability in the use of skeletal surveys at children’s hospitals
  • There is even greater variability in the use of skeletal surveys at general hospitals
  • Clinical decision support tools are beneficial
  • Continuous quality improvement is needed

The brief also includes critical recommendations for hospitals, funders, and policymakers to help address disparities and protect all at-risk children from potential further harm.

For hospitals, the researchers note the importance of evidence-based, patient-specific clinical guidelines for child abuse evaluation and continuous evaluation and quality improvement for the implementation of those guidelines.

“Findings from PolicyLab and other institutions suggest that implementation of injury-specific clinical guidelines using clinical decision support tools may improve appropriate use of skeletal survey, reduce disparities in care, and increase detection of occult injuries that are indicative of abuse,” the report concludes.

The brief is available to review online.