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Dean JR, Kaczor K, Lorenz D, Mason M, Simonton K. Characteristics of child abuse fatalities: Insights from a statewide violent death reporting system. CHILD ABUSE & NEGLECT 2024; 149:106649. [PMID: 38295604 DOI: 10.1016/j.chiabu.2024.106649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/13/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Child maltreatment fatalities are a significant public health issue. Case level characteristics of abuse-related deaths can increase our understanding of maltreatment fatalities and inform region-specific prevention initiatives. OBJECTIVE Explore child abuse fatalities in the Illinois Violent Death Reporting System (IVDRS) for commonalities and distinctive features. METHODS, PARTICIPANTS AND SETTING A mixed methods study was conducted using IVDRS data from 2015 to 2018. All fatalities with a homicide or undetermined manner of death among decedents 10 years old or younger were included. Both discrete and narrative data were analyzed separately for victim, suspect, circumstance, and household characteristics. RESULTS Of the 106 deaths that met inclusion criteria, 74 % of homicide deaths (64/86) and 50 % of undetermined deaths (10/20) were due to abuse. Psychosocial characteristics most often identified in abusive deaths included family relationship problems, mental illness, and history of substance abuse. Other common characteristics included use of personal weapons or blunt instruments and death due to punishment. Including narrative data rather than discrete data alone identified 148 % more deaths with three characteristics commonly found in abusive deaths: history of abuse, shaken baby syndrome, and family history of violence. CONCLUSION This study demonstrates the capability of multi-source state-level data to enrich our understanding of child abuse fatalities. Employing the narrative review method in other states using the National Violent Death Reporting System may increase the identification of abuse fatalities. Improved recognition and characterization of abuse fatalities has the potential to help address systemic factors involved and enhance targeted prevention efforts. WHAT IS KNOWN Child abuse fatalities represent a significant and preventable public health issue in the United States. Case-specific characteristics are limited in national data sets, and their absence curtails prevention opportunities. WHAT THIS STUDY ADDS State-wide reporting systems of violent deaths offer rich and multisource data regarding child abuse fatalities including detailed victim, suspect, circumstance, and household characteristics. This data can be used to enhance our knowledge of maltreatment fatalities and may inform region-specific public health and prevention initiatives.
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Affiliation(s)
- Julie Robin Dean
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Kim Kaczor
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA.
| | - Doug Lorenz
- Department of Bioinformatics and Biostatistics, University of Louisville, 485 E. Gray St. Louisville, KY 40202, USA.
| | - Maryann Mason
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - Kirsten Simonton
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA.
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Gregory K, Fingarson A, Pierce MC, Budde S, Lorenz D, Charleston E, Rosado N. Examining Cases of Child Physical Abuse Evaluations to Identify Opportunities to Improve Intimate Partner Violence Screening in Pediatric Emergency Departments. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11429-11444. [PMID: 37421199 DOI: 10.1177/08862605231182379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
The association between child maltreatment and intimate partner violence (IPV) is well supported. Universal IPV screening has been recommended by the American Academy of Pediatrics and the United States Preventative Task Force, and many children's hospitals have established screening protocols. However, the yield and best screening method in families undergoing a child physical abuse (PA) evaluation have not been fully explored. To determine if there is a discrepancy in IPV disclosures between universal IPV screening completed during pediatric emergency department (PED) triage ("triage screening") and IPV screening by a social worker ("social work screening") in families of children who were evaluated for PA. Caregivers of children who presented to an urban tertiary PED and underwent an evaluation for PA via a child abuse pediatrics consult. A retrospective chart review was completed. Data collection included: caregiver responses to both triage screening and social work screening, interview setting details and participants, the child's injuries, and details of the family's reported IPV experiences. Our study (N = 329) revealed that social work screening produced significantly more positive IPV disclosures than triage screening (14.0% vs. 4.3%, p < .001). Additionally, non-IPV violence concerns were identified in 35.7% (n = 5) of the positive triage screens, whereas social work screens had none. These results highlight the benefits of IPV screening by social work in high-risk scenarios, such as child PA evaluations, regardless of universal IPV screening results. Exploring differences between the two screening methods can inform decisions about screening protocols to improve IPV identification in high-risk populations.
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Affiliation(s)
- Kelsey Gregory
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | | | | | - Stephen Budde
- Juvenile Protective Association, Chicago, IL, USA
- University of Chicago Crown Family School of Social Work, Policy and Practice, IL, USA
| | - Douglas Lorenz
- University of Louisville School of Public Health and Information Science, KY, USA
| | | | - Norell Rosado
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
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3
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Luke MJ, Vasan A. From Incentives to Outcomes: A Framework for Implementing and Evaluating Social Needs Interventions. Hosp Pediatr 2023; 13:e295-e298. [PMID: 37718960 PMCID: PMC11212815 DOI: 10.1542/hpeds.2023-007375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Michael J Luke
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aditi Vasan
- PolicyLab and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Chaiyachati BH, Wood JN. Brief resolved unexplained events vs. child maltreatment: a review of clinical overlap and evaluation. Pediatr Radiol 2021; 51:866-871. [PMID: 33999231 DOI: 10.1007/s00247-020-04793-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/01/2020] [Accepted: 08/04/2020] [Indexed: 10/21/2022]
Abstract
Within their first year, a number of infants present for medical evaluation because of unexplained changes in color, tone, breathing, or level of responsiveness. This broad collection of symptoms has an accordingly large differential diagnosis that includes both brief resolved unexplained event (BRUE) and child maltreatment. The overlap between clinical presentation for BRUE and maltreatment can present a diagnostic challenge - especially given the significant consequences for infants and families for diagnostic error at that juncture. In this review, we provide overviews of the presenting features and findings in cases of BRUE and child maltreatment with a focus on areas of overlap and differentiation.
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Affiliation(s)
- Barbara H Chaiyachati
- Division of General Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Safe Place: The Center for Child Protection and Health, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Joanne N Wood
- Division of General Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,Safe Place: The Center for Child Protection and Health, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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5
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Foley DJ, Hannon JK, O'Gorman CS, Murphy AM. Evaluating documentation of social history in paediatric medical notes at a regional paediatric centre - a quality improvement initiative. BMC Pediatr 2020; 20:505. [PMID: 33143681 PMCID: PMC7640654 DOI: 10.1186/s12887-020-02395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A child's home and family environment plays a vital role in neuro-cognitive and emotional development. Assessment of a child's home environment and social circumstances is an crucial part of holistic Paediatric assessment. AIMS Our aim is to achieve full compliance with comprehensive documentation of biopsychosocial history, for all children medically admitted to the children's inpatient unit in University Hospital Limerick. METHODS We performed a retrospective chart review to audit documentation within our department. This was followed by teaching interventions and a survey on knowledge, attitudes and behaviour of paediatric non-consultant hospital doctors (NCHDs) towards the social history. We performed two subsequent re-audits to assess response to our interventions, and provided educational sessions to seek improvement in quality of care. RESULTS Results showed a significant improvement in quality of documentation following interventions, demonstrated by a net increase of 53% in levels of documentation of some social history on first re-audit. Though this was not maintained at an optimum level throughout the course of the year with compliance reduced from 95% to 82.5% on second re-audit, there was nonetheless a sustained improvement from our baseline. Our qualitative survey suggested further initiatives and educational tools that may be helpful in supporting the ongoing optimisation of the quality of documentation of social history in our paediatric department. CONCLUSION We hope this quality improvement initiative will ultimately lead to sustained improvements in the quality of patient-centred care, and early identification and intervention for children at risk in our community.
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Affiliation(s)
- D J Foley
- Department of Paediatrics, University Hospital Limerick, Dooradoyle, Limerick, Ireland.
| | - J K Hannon
- Department of Paediatrics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - C S O'Gorman
- Department of Paediatrics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - A M Murphy
- Department of Paediatrics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
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Gregory KA, Fingarson AK. Bruising in Infants and Children: Minor Skin Injuries Can Have Major Implications. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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The Art and Science of the Psychosocial Assessment: Impact on Physical Abuse Evaluations in the Emergency Department Setting. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Keeshin B, Forkey HC, Fouras G, MacMillan HL. Children Exposed to Maltreatment: Assessment and the Role of Psychotropic Medication. Pediatrics 2020; 145:peds.2019-3751. [PMID: 31964760 DOI: 10.1542/peds.2019-3751] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians regularly care for children who have experienced child maltreatment. Child maltreatment is a risk factor for a broad range of mental health problems. Issues specific to child maltreatment make addressing emotional and behavioral challenges among maltreated children difficult. This clinical report focuses on 2 key issues necessary for the care of maltreated children and adolescents in pediatric settings: trauma-informed assessments and the role of pharmacotherapy in maltreated children and adolescents. Specific to assessment, current or past involvement of the child in the child welfare system can hinder obtaining necessary information or access to appropriate treatments. Furthermore, trauma-informed assessments can help identify the need for specific interventions. Finally, it is important to take both child welfare system and trauma-informed assessment approaches into account when considering the use of psychotropic agents because there are critical diagnostic and systemic issues that affect the prescribing and discontinuing of psychiatric medications among children with a history of child maltreatment.
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Affiliation(s)
- Brooks Keeshin
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Heather C Forkey
- Department of Pediatrics, University of Massachusetts Medical School, UMass Memorial Children's Medical Center, Worcester, Massachusetts
| | - George Fouras
- Los Angeles County Department of Mental Health, Child Welfare Bureau, Continuum of Care Reform Division, Los Angeles, California; and
| | - Harriet L MacMillan
- Departments of Psychiatry and Behavioural Neurosciences and Pediatrics, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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Lindberg DM. Bias and Objectivity When Evaluating Social Risk Factors for Physical Abuse: of Babies and Bathwater. J Pediatr 2018; 198:13-15. [PMID: 29551314 PMCID: PMC6019184 DOI: 10.1016/j.jpeds.2018.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/02/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel M Lindberg
- Kempe Center for the Prevention & Treatment of Child Abuse & Neglect Department of Emergency Medicine University of Colorado School of Medicine Aurora, Colorado.
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10
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Young A, Pierce MC, Kaczor K, Lorenz DJ, Hickey S, Berger SP, Schmidt SM, Fingarson A, Fortin K, Thompson R. Are negative/unrealistic parent descriptors of infant attributes associated with physical abuse? CHILD ABUSE & NEGLECT 2018; 80:41-51. [PMID: 29567456 PMCID: PMC5953822 DOI: 10.1016/j.chiabu.2018.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/25/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Parents' perceptions of child behavior influence their responses to the child and may be important predictors of physical abuse. We examined whether infants 12 months of age or younger who were described with negative or developmentally unrealistic words were more likely than other infants to have been physically abused. As part of a prospective observational multicenter study investigating bruising and familial psychosocial characteristics, parents were asked to (1) describe their child's personality, and (2) list three words to describe their child. Four independent raters coded parent responses using a qualitative content analysis, identifying descriptors of infants and classifying each as positive, neutral, or negative/unrealistic. A medical expert panel, blinded to the psychosocial data, separately categorized each case as abuse or accident. We then analyzed the potential association between negative/unrealistic descriptors and abusive injury. Of 185 children enrolled, 147 cases (79%) were categorized as accident and 38 (21%) as abuse. Parents used at least one negative/unrealistic descriptor in 35/185 cases (19%), while the remaining 150 cases (81%) included only positive or neutral descriptors. Of the infants described with negative/unrealistic words, 60% were abused, compared to 11% of those described with positive or neutral words (p < .0001; age group-adjusted OR = 9.95; 95% confidence interval [3.98, 24.90]). Though limited by sample-size, this pilot study informs future work to create a screening tool utilizing negative/unrealistic descriptors in combination with other predictive factors to identify infants at high risk for physical child abuse.
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Affiliation(s)
- Audrey Young
- Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL 60611, USA; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, USA
| | - Mary Clyde Pierce
- Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL 60611, USA; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, USA.
| | - Kim Kaczor
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, USA
| | - Douglas J Lorenz
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray St., Louisville, KY 40202, USA
| | - Sheila Hickey
- Department of Social Work, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, USA
| | - Susan P Berger
- Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL 60611, USA; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, USA
| | - Suzanne M Schmidt
- Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL 60611, USA; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, USA
| | - Amanda Fingarson
- Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL 60611, USA; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL 60611, USA
| | - Kristine Fortin
- Division of General Pediatrics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Richard Thompson
- Richard H. Calica Center for Innovation in Children and Family Services, Juvenile Protective Association, 1707 N Halsted St, Chicago, IL 60614, USA; Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA
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11
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Tieder JS, Bonkowsky JL, Etzel RA, Franklin WH, Gremse DA, Herman B, Katz ES, Krilov LR, Merritt JL, Norlin C, Percelay J, Sapién RE, Shiffman RN, Smith MBH. Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. Pediatrics 2016; 137:peds.2016-0590. [PMID: 27244835 DOI: 10.1542/peds.2016-0590] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This is the first clinical practice guideline from the American Academy of Pediatrics that specifically applies to patients who have experienced an apparent life-threatening event (ALTE). This clinical practice guideline has 3 objectives. First, it recommends the replacement of the term ALTE with a new term, brief resolved unexplained event (BRUE). Second, it provides an approach to patient evaluation that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Finally, it provides management recommendations, or key action statements, for lower-risk infants. The term BRUE is defined as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper- or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination. By using this definition and framework, infants younger than 1 year who present with a BRUE are categorized either as (1) a lower-risk patient on the basis of history and physical examination for whom evidence-based recommendations for evaluation and management are offered or (2) a higher-risk patient whose history and physical examination suggest the need for further investigation and treatment but for whom recommendations are not offered. This clinical practice guideline is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient outcomes, support implementation, and provide direction for future research. Each key action statement indicates a level of evidence, the benefit-harm relationship, and the strength of recommendation.
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Fortin K, Kwon S, Pierce MC. Characteristics of Children Reported to Child Protective Services for Medical Neglect. Hosp Pediatr 2016; 6:204-10. [PMID: 26931563 DOI: 10.1542/hpeds.2015-0151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Medical neglect can have serious consequences. There is little evidence base to guide medical neglect management and research. Our objective was to describe a group of children reported to child protective services (CPS) for medical neglect to define this population as well as identify prevention and intervention approaches. METHODS This was a retrospective descriptive study of all patients at a pediatric hospital reported to CPS for medical neglect over a 6-year period. Data about health, health care, CPS involvement, and social history were obtained through medical record review. RESULTS Of the 154 patients reported for medical neglect, 140 (91%) had chronic illness. The most common diagnoses were type 1 diabetes, organ transplantation, and prematurity-related conditions. Most patients (83%) were black or Hispanic and 90% were publically insured. More than half of patients (54%) had >1 CPS report during the study period. Almost all patients (88%) returned to the hospital for care subsequent to the medical neglect report. Risk factors for child maltreatment, family stressors in the year preceding the report, and practical barriers to care were documented in more than two-thirds of patients. CONCLUSIONS Overall, children reported for medical neglect have serious chronic medical conditions. There is need and opportunity for improved interventions. Avenues for future study include interventions tailored to the underlying diagnosis, racial/ethnic disparities, effectiveness of CPS interventions, and targeted prevention for at-risk families with medically complex children.
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Affiliation(s)
- Kristine Fortin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Mary Clyde Pierce
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Moyer DL, Carpenter JM, Landon MA, Mack DT, Kenyon JL, Champion SA. Nonaccidental trauma: guidance for nurses in the pediatric intensive care unit. Crit Care Nurs Clin North Am 2015; 27:167-81. [PMID: 25981721 DOI: 10.1016/j.cnc.2015.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Each year thousands of children are hospitalized for traumatic injuries associated with physical abuse. Nurses in the pediatric intensive care unit must be knowledgeable and skilled in caring for the physical, psychological, emotional, social, and developmental needs of such children and their families. This article provides direction for pediatric nurses working in the critical care setting. Specifically, it describes the nursing care of children in a pediatric intensive care unit where the mechanism of nonaccidental injury is blunt force to the head, abdomen, or musculoskeletal system, based on standards put forth by the American Association of Critical-Care Nurses.
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Affiliation(s)
- Donna L Moyer
- Department of Nursing Professional Practice, Bronson Children's Hospital, 601 John Street, Kalamazoo, MI 49007, USA.
| | - Jennifer M Carpenter
- Department of Education Services, Bronson Children's Hospital, 601 John Street, Kalamazoo, MI 49007, USA
| | - Margaret A Landon
- Department of Pediatric Intensive Care Unit, Bronson Children's Hospital, 601 John Street, Kalamazoo, MI 49007, USA
| | - Dorothy T Mack
- Department of Pediatric Intensive Care Unit, Bronson Children's Hospital, 601 John Street, Kalamazoo, MI 49007, USA
| | - Jennifer L Kenyon
- Department of Pediatric Intensive Care Unit, Bronson Children's Hospital, 601 John Street, Kalamazoo, MI 49007, USA
| | - Samara A Champion
- Department of Pediatric Intensive Care Unit, Bronson Children's Hospital, 601 John Street, Kalamazoo, MI 49007, USA
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