Introduction: Child abuse is a leading cause of morbidity and mortality in children. The rate of missed child abuse in general emergency departments (ED), where 85% of children are evaluated, is higher than in pediatric EDs. We sought to evaluate the impact of an electronic health record (EHR)-embedded child-abuse clinical decision support system (CA-CDSS) in the identification and evaluation of child maltreatment in a network of EDs three years after implementation.
\nMethods: We anonymously surveyed all 196 ED attending physicians and advanced practice practitioners (APP) in the University of Pittsburgh Medical Center network. The survey evaluated practitioner awareness of, attitudes toward, and changes in clinical practice prompted by the CA-CDSS. We also assessed practitioner recognition and evaluation of sentinel injuries.
\nResults: Of the 71 practitioners (36%) who responded to the survey, 75% felt the tool raised child abuse awareness, and 72% had a face-to-face discussion with the child’s nurse after receiving a CA-CDSS alert. Among APPs, 72% consulted with the attending physician after receiving an alert. Many practitioners were unaware of at least one function of the CA-CDSS; 38% did not know who completed the child abuse screen (CAS); 54% were unaware that they could view the results of the CAS in the EHR, and 69% did not recognize the clinical decision support dashboard icon. Slightly over 20% of respondents felt that the CA-CDSS limited autonomy; and 4.5% disagreed with the recommendations in the physical abuse order set, which reflects American Academy of Pediatrics (AAP) guidelines. Greater than 90% of respondents correctly identified an intraoral injury and torso bruise in an infant as sentinel injuries requiring an evaluation for abuse.
\nConclusion: A child-abuse clinical decision support system embedded in the electronic health record was associated with communication among practitioners and was overall perceived as improving child abuse awareness in our system. Practitioners correctly recognized injuries concerning for abuse. Barriers to improving identification and evaluation of abuse include gaps in knowledge about the CA-CDSS and the presence of practitioners who disagree with the AAP recommendations for physical abuse evaluation and/or felt that clinical decision support in general limited their clinical autonomy.
","language":null,"license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Child abuse"},{"word":"Electronic Health Record"},{"word":"clinical decision support"}],"section":"Pediatrics","is_remote":true,"remote_url":"https://escholarship.org/uc/item/98f405hj","frozenauthors":[{"first_name":"Alanna","middle_name":"C.","last_name":"Peterson","name_suffix":"","institution":"University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania","department":""},{"first_name":"Donald","middle_name":"M.","last_name":"Yealy","name_suffix":"","institution":"University of Pittsburgh, Department of Emergency Medicine, Pittsburgh, Pennsylvania","department":""},{"first_name":"Emily","middle_name":"","last_name":"Heineman","name_suffix":"","institution":"University of Pittsburgh, UPMC Children’s Hospital of Pittsburgh, Division of Child Advocacy, Department of Pediatrics, Pittsburgh, Pennsylvania","department":"None"},{"first_name":"Rachel","middle_name":"P.","last_name":"Berger","name_suffix":"","institution":"University of Pittsburgh, UPMC Children’s Hospital of Pittsburgh, Division of Child Advocacy, Department of Pediatrics, Pittsburgh, Pennsylvania; Pennsylvania Office of Children, Youth and Families, Harrisburg, Pennsylvania","department":""}],"date_submitted":"2023-10-18T03:36:25+08:00","date_accepted":"2024-07-18T02:22:19.970000+08:00","date_published":"2024-10-14T21:00:00+08:00","render_galley":{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18501/galley/28643/download/"},"galleys":[{"label":"Layout","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18501/galley/26299/download/"},{"label":"Final Article","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/18501/galley/28643/download/"}]}