405 - Does a positive "Safe Environment for Every Kid" (SEEK) Screen correlate to increased risk of injury in pediatric patients?

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 405
Publication Number: 405.206

Laura C. Burns, Case Western Reserve University School of Medicine, cleveland heights, OH, United States

Presenting Author(s)

Laura C. Burns (she/her/hers)

Medical Student
Case Western Reserve University School of Medicine
cleveland heights, Ohio, United States

Background: The Safe Environment for Every Kid (SEEK) Screen is a tool for primary care physicians to assess for risks in patients’ environments. Studies have shown that actions taken in response to SEEK screening can result in reduced child maltreatment. However, there have been few studies that assess how accurately the SEEK screen actually reflects the likelihood of childhood injury.

Objective: To determine whether children who screened positively on the SEEK screen in any domain before age 2 were at an increased risk of injury by age 3. Secondary aims were to assess whether a positive screen in harsh parenting was more closely correlated to maltreatment causes of injury, and whether a positive screen in substance use or depression was more closely correlated to unintentional injuries.

Design/Methods: Retrospective cohort study of children presenting for primary care at a large urban resident continuity clinic. The cohort included patients with at least two lifetime visits to the practice who were less than 2 years old and completed a SEEK screen between April 1, 2021 and September 30, 2021. Descriptive statistics were used to characterize frequency and nature of injuries among patients. Covariates that were assessed included number of interactions with ED, primary care, and urgent care, patient comorbidities, vaccine status, and BMI

Results: Of the 438 patients meeting inclusion criteria, 317 (72.4%) screened negative in all SEEK domains and 121 (27.6%) screened positive for at least one domain, the most common being stress. 8 screened positive for harsh punishment style, and 55 had a caregiver reporting substance use (7) and/or depression (48). Only 56 (12.8%) patients experienced an injury during the review period. Positive SEEK screens were more common among patients with public or self-pay insurance and injuries were more common among older patients. In multivariable models accounting for insurance type and age at index visit, there was no significant difference in likelihood of injury according to SEEK result.

Conclusion(s): Based on our findings, there does not seem to be a significant difference in rate of injury between SEEK positive and SEEK negative pediatric patients. However, the current study is limited by a relatively small sample size and an even smaller proportion of the sample who experienced an injury. These findings raise the question of whether there is truly a low frequency of injury in our population, or, if many children experience injuries which are not assessed by healthcare professionals. Future research could build on our findings by studying a larger population of pediatric patients.