P0233 - Predictors of Child Protective Services Reporting Among Children Presenting to the Emergency Department with Fractures

Purpose: Approximately one-fourth of the estimated 676,000 children in the US who were victims of abuse and neglect in 2016 were less than 3 years of age. Fractures are a common manifestation of child abuse. To our knowledge, no research study to date has examined the factors associated with medical staff filing Child Protective Services (CPS) reports of suspected abuse among pediatric patients seen in the Emergency Department (ED) with fractures. Therefore, we aim to study children less than 3 years of age who presented to the ED with at least one fracture in order to describe types of presenting fractures, and to identify factors associated with CPS filing.

Methods: A retrospective chart review was performed on all patients less than 3 years of age with a diagnosis of fracture seen in the ED from January 1, 2017-December 31, 2018. Data collected include demographics (age, sex, race, and insurance type) and information regarding the patients’ fracture(s), history, work-up, and outcome. Patients with known metabolic or other bone disease were excluded as were subsequent emergency room visits for the same fracture.

Results: 302 children presented with fractures. There were 103 skull, 87 upper extremity, 77 lower extremity and 35 trunk or chest fractures. 56 (18.5%) were reported to CPS. Younger age, African American race, skull fractures, hospital admissions, and absence of a witness resulted in increased odds of CPS reports in simple logistic regression analyses. These factors were entered simultaneously into a multiple regression model to understand which predictors had the best explanatory power. Younger age (OR = .905, 95% CI: .866 – .946, P < .001), hospital admission (OR = 2.99, 95% CI: 1.434-6.217, P = .003) and absence of a witness (OR = .161, 95% CI: .076-.338, P < .001) were significant predictors of CPS report filing. Race and fracture type were no longer significant predictors in the multiple regression model.

Conclusion: Using a retrospective chart review, we found that there was an increased odds of physicians filing CPS reports when children <3 years of age presented to the ED with fractures if the child was younger, admitted to the hospital, and had no witness to the situation resulting in injury.