Emergency Medicine: All Areas
Emergency Medicine 11
Joseph Shapiro, MD, HEC-C (he/him/his)
Pediatric Emergency Medicine Fellow
Boston Medical Center
Boston, Massachusetts, United States
Encounters for the evaluation and management of unintentional ingestions by young children are common in pediatric emergency departments (PED). The frequency with which these cases are referred to Child Protective Services (CPS) for evaluation of neglect is unclear. Disproportionality in PED evaluations of suspected physical abuse have been reported, and similar disparities may exist in cases of suspected neglect in the context of unintentional ingestions.
The study objective was to examine the percentage and characteristics of patients presenting to the PED for unintentional ingestions who are referred to CPS.
We conducted a retrospective cohort analysis of children aged ≤11 years old who presented to an urban PED between June 2014 and December 2020 for an unintentional ingestion. Patients were identified by querying the hospital electronic data warehouse for PED encounters with International Classification of Diseases codes corresponding to unintentional ingestions. Patient demographics, type of ingestion, disposition, and referrals to CPS were abstracted by manual chart review. Our primary outcome of CPS referral was assessed based on provider documentation of a CPS filing in the medical record. Logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the association between the primary outcome and predictor variables (demographics and clinical circumstances).
We identified 129 PED encounters for unintentional ingestions that were included for analysis. Demographics and ingestion types are reported in Table 1. Overall, 22 patients (17.1%) were referred to CPS for neglect. Hispanic patients had higher odds of referral to CPS than White patients (OR=7.52, 95%CI [1.26-45.03], p=0.03). Though not statistically significant, Black patients also had higher odds of CPS referral (OR=1.88, 95%CI [0.35-10.16]). Patients arriving to the ED by ambulance (p=0.003) and those admitted to the hospital (p=0.001) were more likely to be referred to CPS.
Referrals to CPS for unintentional ingestions presenting to the PED are common. There is disproportionality by race in referrals to CPS which should be further investigated. While a more severe clinical course is more likely to generate a CPS referral, it is unclear if clinical severity is associated with level of neglect or indicative of ongoing risk to the patient. More research is needed to understand current practices and to promote equitable and effective child maltreatment reporting for children presenting to the PED following unintentional ingestions.