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Deutsch SA, O'Brien E. Child torture victimization: Review of criminal statutes and medico-legal issues. Child Abuse Negl 2024; 151:106750. [PMID: 38492536 DOI: 10.1016/j.chiabu.2024.106750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/18/2024]
Abstract
A renowned group of pediatricians and an attorney with expertise in child abuse matters proposed a medical definition of intrafamilial child torture perpetrated by a caretaker in a landmark 2014 publication in the health sciences literature. Representing one of the most widely cited publications on non-politically motivated child torture to date, this medical definition encompassing physical abuse, psychological abuse, deprivation, and neglect characterizing child torture has been broadly recognized and accepted by multidisciplinary professionals across medical, child welfare, and criminal justice sectors. While the medical community's efforts aimed to compel legislative changes, including adoption of explicit torture-specific statutes that would enable criminal justice system responses reflective of abuse severity, subsequent legal analyses have revealed tremendous variability in criminal investigations, prosecution, sentencing, and case outcomes. In this discussion piece, medico-legal issues relevant to intrafamilial child torture case prosecution are reviewed. The impact of the established medical definition on jurisdictional legal approaches and unique case challenges related to longitudinal nature of abuse, frequent psychological injury, and victim-perpetrator dynamics are explored in depth. Utilizing available legal research platforms, investigative information, health sciences literature, and prosecutor self-report, existing child torture statutes and case outcomes were compared with focus on perpetrator, victim, socio-environmental, and community influence on legal outcome. Prosecutorial challenges facing jurisdictions lacking child torture statutes are discussed with emphasis placed on the critical role played by the medical community to support diagnosis of physical and emotional impacts to the child. Finally, the process by which states can establish a jurisdictional torture statute are suggested.
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Affiliation(s)
- Stephanie Anne Deutsch
- Department of Pediatrics, Nemours Children's Health, Delaware, Wilmington, DE, United States of America.
| | - Erin O'Brien
- Chester County District Attorney's Office, West Chester, PA, United States of America.
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Deutsch SA, Einspahr S, Almeida D, Vandergrift D, Loiselle C, De Jong A. Variability in Occult Injury Screening Among Siblings/Household Contacts of Physical Abuse Victims. Pediatr Emerg Care 2024:00006565-990000000-00376. [PMID: 38227815 DOI: 10.1097/pec.0000000000003114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVE The objective of this study is to examine radiologic occult injury screening performance/yield among contacts presenting for precautionary medical assessments and assess factors associated with deferred screening. METHODS Data were collected retrospectively from charts of contacts younger than 8 years presenting for precautionary evaluation to a level 1 pediatric emergency department January 1, 2018 to March 31, 2023. Demographics, radiologic performance/yield, physical examination, social work-based psychosocial assessment, reasons for deferred imaging, and diagnostic codes were abstracted. Descriptive statistics and χ2 analysis are reported. RESULTS Three hundred ninety contacts were identified; 364 (93.3%) were biological siblings. Most (276, 70.8%) were 2 to 8 years old. Statistically significant relationships were identified with age, insurance, and hospital social work assessment and screening. Thirty-four infants (54%) underwent neuroimaging; no studies were abnormal. Of 114 contacts, <2 years old, 97 (85%) underwent skeletal survey (SS); 9 (9%) SS were abnormal. Twenty-seven (24%) returned for follow-up SS; 4 (14.8%) were abnormal. For 2 contacts, an abnormal initial SS was refuted by follow-up imaging. Physical examinations were abnormal for 11% of contacts. Reasons for deferred imaging included contact well appearance, caregiver concerns, and clinician disagreement with indications. Encounter International Classification of Diseases codes varied, commonly reflecting nonspecific screening assessments. CONCLUSIONS Despite national clinical practice guidelines, studies of abusive injury prevalence and radiologic yield among at-risk contacts exposed to unsafe environments are few. Screening evaluations inclusive of physical examination and radiologic studies identify abuse concerns among at-risk contacts. Further study of factors impacting radiologic screening decisions is needed. Considerations to advance epidemiologic research include standardized diagnostic coding and prospective assessment of radiologic yield.
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Affiliation(s)
- Stephanie Anne Deutsch
- From the Department of Pediatrics, Nemours Children's Health, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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Breeden K, Loiselle C, Hossain J, De Jong AR, Deutsch SA. Factors Impacting Maltreatment Evaluation and Reports to Child Protective Services in Pediatric Substance Exposures. Pediatr Emerg Care 2024:00006565-990000000-00371. [PMID: 38206301 DOI: 10.1097/pec.0000000000003115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The objective of this study was to assess demographic, clinical, and psychosocial factors associated with pediatric substance exposures, describe the medical evaluation, and identify factors associated with social work (SW) and hospital-based child protection team (CPT) safety assessments and reports to child protective services (CPS). METHODS We retrospectively reviewed charts of electronic medical records for children ages 0 to 72 months presenting for accidental ingestion evaluated May 1, 2015 to May 1, 2021 at a level 1 pediatric trauma center. Cases of environmental exposures, iatrogenic medication errors, dosing errors, and allergies/adverse reactions were excluded. Data were analyzed using descriptive statistics; χ2 and multivariable logistic regression analysis assessed factors associated with two primary outcomes of interest, SW/CPT assessment and CPS report. RESULTS Among 773 total cases of substance exposures during the studied time frame, 27% were referred to SW/CPT for further safety assessments and 15.4% were reported to CPS. Being admitted to the hospital, prescription medication or recreational/illegal/illicit substance exposures, and increasing psychosocial risk factors were found to be significantly associated with referrals. Age, race, and insurance status were not found to be associated. Toxicology screening was performed in only 24.7% of cases. Of those eligible for further imaging per hospital protocol, skeletal surveys were obtained in 5.5% of cases and head imaging was obtained in 9% of cases. CONCLUSIONS There is significant variability in pediatric substance exposure assessment practices. Disparities based on demographic characteristics are uncommon. Perceived severity of condition, exposures involving recreational/illegal/illicit substances, and greater prevalence of family psychosocial adversities are associated with higher rates of SW/CPT assessment and CPS reports.
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Affiliation(s)
- Karli Breeden
- From the Department of Pediatrics, Nemours Children's Health, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Claire Loiselle
- From the Department of Pediatrics, Nemours Children's Health, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Jobayer Hossain
- Biostatistics Core, Nemours Biomedical Research, Nemours Children's Health, Wilmington, DE
| | - Allan R De Jong
- From the Department of Pediatrics, Nemours Children's Health, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Stephanie Anne Deutsch
- From the Department of Pediatrics, Nemours Children's Health, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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Deutsch SA, De Jong AR. Xylazine Complicating Opioid Ingestions in Young Children. Pediatrics 2023; 151:190352. [PMID: 36550066 DOI: 10.1542/peds.2022-058684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 12/24/2022] Open
Abstract
The authors of this report present 3 cases of synthetic opioid intoxication complicated by the concomitant presence of the additive xylazine, a nonopioid sedative analgesic and muscle relaxant used in veterinary medicine that potentiates respiratory depression associated with the opioid toxidrome. Three exposed children presented with severe signs and symptoms, 2 of whom experienced cardiac arrest, a need for continuous naloxone infusion or multiple naloxone doses, or mechanical ventilation to treat respiratory failure after their exposures. Additives were detected in urine studies only through the performance of specialized toxicology testing. Detection of xylazine among adult overdose deaths has recently increased sharply, particularly across the northeastern United States. Adulteration by xylazine is an emerging public health threat nationally. Our report reveals that pediatricians should be aware of sentinel drug trends among adults, including the emerging types of illicit, synthetic, or counterfeit formulations of recreational substances, because children may be harmed because of accidental or intentional exposure. Children exposed to dangerous substances also need child protection services that may entail safe relocation outside of the home and the referral of affected caregivers to necessary substance use treatment services. Given epidemic drug use among adults, pediatricians should be competent to recognize common toxidromes and be aware that signs and symptoms may be potentiated by synergistic novel additives or polysubstance exposures. Importantly, standard urine drug screens may not detect synthetic opioid derivatives or contributing additives, so that diagnosis will require specialized toxicology testing.
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Deutsch SA, Zomorrodi A, Zent J, Kirk A, O'Brien P, Loiselle C, De Jong A. Hospital Costs, Revenue, and Abuse Detection Associated With Occult Injury Screening. Acad Pediatr 2022; 22:989-996. [PMID: 35367403 DOI: 10.1016/j.acap.2022.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Performance of occult injury screening including skeletal surveys and neuroimaging is recommended to comprehensively evaluate suspected child physical abuse. Screening performance-associated hospital costs and net revenue for care of index abuse victims and siblings/household contacts are largely unknown. We aimed to describe 1) costs and net revenue associated with radiologic occult injury screening at an urban level 1 pediatric trauma center, 2) areas of perceived high resource intensity (time spent in abuse victim-related care), and 3) detection yield among children undergoing occult injury screening and physical assessment. METHODS Using time-driven activity-based cost analysis, hospital, per physician, staff, and radiology costs associated with occult injury screening performance were mapped for 199 children <2 years old. Hospital costs and resource times were approximated and compared with net revenue for each healthcare encounter. Abstracted variables included index/sibling status, injury classification, and length of stay (LOS). RESULTS Of 199 children with variable LOS (0-45 days), total hospital costs (facility, physician, staff, radiology) ranged $297.83 to $81,474; net revenue was positive. Total ED time per abuse case varied 32 to 1823 minutes; social work (SW) time ranged 44 to 720 minutes; prolonged ED/SW time represented resource-intense areas. Of siblings, 27% were diagnosed with unanticipated findings based on occult injury screening and examination. CONCLUSIONS At a single center, occult injury screening was associated with cost variability, resource intensity, and enhanced victim identification when external examination findings or clinical symptoms were absent. While further study is needed, cost and resource concerns associated with screening may be offset by societal benefit and minimal hospital-based financial losses.
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Affiliation(s)
- Stephanie Anne Deutsch
- Department of Pediatrics (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Nemours Children's Health, Wilmington, Del; Sidney Kimmel Medical College of Thomas Jefferson University (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Philadelphia, Pa.
| | - Arezoo Zomorrodi
- Department of Pediatrics (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Nemours Children's Health, Wilmington, Del; Sidney Kimmel Medical College of Thomas Jefferson University (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Philadelphia, Pa
| | - James Zent
- Department of Organizational Finance (J Zent, A Kirk and P O'Brien), Nemours Children's Health, Wilmington, Del
| | - Alexander Kirk
- Department of Organizational Finance (J Zent, A Kirk and P O'Brien), Nemours Children's Health, Wilmington, Del
| | - Paul O'Brien
- Department of Organizational Finance (J Zent, A Kirk and P O'Brien), Nemours Children's Health, Wilmington, Del
| | - Claire Loiselle
- Department of Pediatrics (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Nemours Children's Health, Wilmington, Del; Sidney Kimmel Medical College of Thomas Jefferson University (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Philadelphia, Pa
| | - Allan De Jong
- Department of Pediatrics (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Nemours Children's Health, Wilmington, Del; Sidney Kimmel Medical College of Thomas Jefferson University (SA Deutsch, A Zomorrodi, C Loiselle and A De Jong), Philadelphia, Pa
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Deutsch SA, Teeple E, Dickerman M, Macaulay J, Collins G. For Victims of Fatal Child Abuse, Who Has the Right to Consent to Organ Donation? Pediatrics 2020; 146:peds.2020-0662. [PMID: 32817267 DOI: 10.1542/peds.2020-0662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/24/2022] Open
Abstract
In rare circumstances, children who have suffered traumatic brain injury from child abuse are declared dead by neurologic criteria and are eligible to donate organs. When the parents are the suspected abusers, there can be confusion about who has the legal right to authorize organ donation. Furthermore, organ donation may interfere with the collection of forensic evidence that is necessary to evaluate the abuse. Under those circumstances, particularly in the context of a child homicide investigation, the goals of organ donation and collection and preservation of critical forensic evidence may seem mutually exclusive. In this Ethics Rounds, we discuss such a case and suggest ways to resolve the apparent conflicts between the desire to procure organs for donation and the need to thoroughly evaluate the evidence of abuse.
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Affiliation(s)
| | - Erin Teeple
- Division of Pediatric Surgery, Department of Surgery
| | | | - Jennifer Macaulay
- Department of Patient and Family Services, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Gary Collins
- Medical Examiner Unit, Division of Forensic Science, and
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Deutsch SA, Donahue J, Parker T, Hossain J, De Jong A. Factors Associated with Child-Welfare Involvement among Prenatally Substance-Exposed Infants. J Pediatr 2020; 222:35-44.e1. [PMID: 32418814 PMCID: PMC8064022 DOI: 10.1016/j.jpeds.2020.03.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/25/2020] [Accepted: 03/17/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess factors impacting child-welfare involvement and child abuse and neglect outcomes among prenatally substance-exposed infants. STUDY DESIGN This was a retrospective review of case registry data regarding substance-exposed infants tracked statewide in Delaware from 2014 to 2018. Differences in maternal, infant, and substance exposure factors by level of child-welfare involvement (screened-in vs screened-out case status) and child abuse and neglect outcomes were examined. Screened-in status was defined as case acceptance for investigation, family assessment, or treatment referral. Using logistic regression, associations between factors and screened-in status and between factors and child abuse and neglect outcomes were assessed. Cases involving child abuse and neglect were analyzed qualitatively. RESULTS Among 1222 substance-exposed infants, 70% were screened-in by child welfare for ongoing involvement; 28 (2.3%) of substance-exposed infants were identified as child abuse and neglect victims sustaining serious physical or fatal injury before 1 year of age. Most substance-exposed infants remained with caregivers; few entered foster care. Polysubstance exposure and maternal mental health condition were factors associated with screened-in status. Neither substance exposure type nor maternal mental health condition reliably predicted future child abuse and neglect. CONCLUSIONS Substance-exposed infants had a significant risk for child abuse and neglect. Although maternal and substance exposure factors were associated with screened-in case status, they unreliably predicted future risk of child abuse and neglect.
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Affiliation(s)
- Stephanie Anne Deutsch
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
| | | | - Trenee Parker
- Department of Services for Children, Youth and their Families, Wilmington, DE
| | - Jobayer Hossain
- Biostatistics Core, Nemours Biomedical Research, Nemours Children’s Health System, Wilmington, DE
| | - Allan De Jong
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE and Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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Affiliation(s)
- Jennifer Macaulay
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and
| | - Adeline Melvin
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and
| | - Stephanie Anne Deutsch
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and .,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Reese S, Deutsch SA. Sexual Assault Victimization Among Children and Youth With Developmental Disabilities: Responding With Trauma-Informed Care. J Forensic Nurs 2020; 16:55-60. [PMID: 32068678 DOI: 10.1097/jfn.0000000000000278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sexual assault victimization is a traumatic experience for children and youth, and care of survivors requires a trauma-informed approach. Children and youth with developmental disabilities are sexually victimized at higher rates than those without disabilities. Children with autism spectrum disorder (ASD), in particular, may be at an increased risk for both traumatic events and developing traumatic sequelae after sexual assault victimization. In this report, we present the case of a youth with ASD who sought acute sexual assault care, but whose care was compromised because of multiple systems failures, including gaps in communication regarding her unique needs, and inconsistent knowledge among multidisciplinary team members regarding necessary adaptations in the implementation of trauma-informed care for youth with ASD. Lessons learned, including proposed solutions to improve communication and education, and approaches to prevent unintended retraumatization are discussed.
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Levy C, Weeks KS, Benson RJ, Miller JM, Higgins J, Deutsch SA, Lantos JD. Failure to Provide Adequate Palliative Care May Be Medical Neglect. Pediatrics 2019; 144:peds.2018-3939. [PMID: 31484675 DOI: 10.1542/peds.2018-3939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 11/24/2022] Open
Abstract
Doctors are required to notify Child Protective Services (CPS) if parents do not provide appropriate medical care for their children. But criteria for reporting medical neglect are vague. Which treatments properly fall within the realm of shared decision-making in which parents can decide whether to accept doctors' recommendations? Which treatments are so clearly in the child's interest that it would be neglectful to refuse them? When to report medical neglect concerns to CPS may be controversial. It would seem inhumane to allow a child to suffer because of parental refusal to administer proper analgesia. In this ethics rounds, we present a case of an adolescent with chronic pain who is terminally ill. Her parents were not adherent to recommended analgesia regimens. Her palliative care team had to decide whether to report the case to CPS.
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Affiliation(s)
- Carly Levy
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.,Sidney Kidney Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kristin S Weeks
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa; and
| | - Rebecca J Benson
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa; and
| | - Jonathan M Miller
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Jennifer Higgins
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.,Sidney Kidney Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stephanie Anne Deutsch
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware.,Sidney Kidney Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John D Lantos
- Center for Bioethics, Children's Mercy Hospital, Kansas City, Missouri
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Deutsch SA, Benyo S, Xie S, Carlin E, Andalaro B, Clagg B, De Jong A. Addressing Human Papillomavirus Prevention During Pediatric Acute Sexual Assault Care. J Forensic Nurs 2018; 14:154-161. [PMID: 30130316 PMCID: PMC6114142 DOI: 10.1097/jfn.0000000000000209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND/OBJECTIVES Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Pediatric sexual assault (SA) victims are a special population eligible for HPV vaccination at the age of 9 years. National clinical practice guidelines advise clinicians to address HPV during emergency department (ED)-based SA care and at follow-up. At our institution, addressing HPV among suspected SA victims was highly variable, and HPV counseling was subsequently recommended on an ED-based acute SA clinical pathway as standard care. The aim of this study was to determine the proportion of age-eligible SA victims who received HPV counseling, determine victim characteristics associated with addressing HPV during SA care, and identify barriers to addressing HPV in the ED. METHODS This study used a retrospective chart review of 448 pediatric SA victims presenting to the ED for acute postassault care. RESULTS HPV was discussed in 10 of 56 (18%) and 37 of 49 (76%) cases in the control versus intervention groups, respectively. To verify vaccination status, caregiver recall was relied upon for 32 of 56 patients in the control group (57%) and 24 of 49 patients in the intervention group (48.9%). Factors associated with failure to discuss HPV during postassault care were younger age at encounter (OR = 0.78, 95% CI [0.67, 0.90], p < 0.001), verbal report of vaccination status verification (OR = 2.98, 95% CI [1.51, 6.01]), and male gender of the victim (OR = 3.35, 95% CI [1.20, 11.94]). CONCLUSIONS Significant barriers to addressing HPV in the ED setting exist, most significantly reliance on caregiver recall to guide vaccination administration, raising concern for overvaccination and undervaccination.
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Affiliation(s)
| | - Sarah Benyo
- Sidney Kimmel Medical College at Thomas Jefferson University
| | | | - Eileen Carlin
- Delaware-CTR ACCEL Program, Nemours/Alfred I. DuPont Hospital for Children
| | - Bridgett Andalaro
- Delaware-CTR ACCEL Program, Nemours/Alfred I. DuPont Hospital for Children
| | - Bernadette Clagg
- Delaware-CTR ACCEL Program, Nemours/Alfred I. DuPont Hospital for Children
| | - Allan De Jong
- Department of General Pediatrics, Alfred I. DuPont Hospital for Children
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Abstract
Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed.
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Affiliation(s)
- Stephanie Anne Deutsch
- Department of Pediatrics, Safe Place: Center for Child Protection and Health, The Children׳s Hospital of Philadelphia, Philadelphia, PA.
| | - Kristine Fortin
- Department of Pediatrics, Safe Place: Center for Child Protection and Health, The Children׳s Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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