Presenter Profile
Stephanie Ruest, MD, MPH
Warren Alpert Medical School, Brown University
Hasbro Children's Hospital
Stephanie_Ruest@brown.edu
Dr. Stephanie Ruest is an Assistant Professor of Pediatrics and Emergency Medicine at Brown University and the Hasbro Children's Hospital Pediatric Emergency Medicine Trauma Liaison. She obtained her medical degree from the University of Massachusetts and completed her general pediatrics residency training at Massachusetts General Hospital. While completing her PEM fellowship at Hasbro Children's Hospital in Providence, RI, she obtained a Masters in Public Health at Brown University. She has ongoing active research focused on child abuse and neglect, accidental pediatric injuries, and social determinants of health, funded through the Rhode Island Injury Control COBRE grant and foundation grants.
Presentations
Characteristics of Pediatric Emergency Department Encounters for Fractures Concerning for Abuse
Stephanie Ruest, MD, MPH
William Rudman MSc
Carsten Eickhoff, PhD
Susan Duffy, MD, MPH
Childhood fractures affect an estimated 20% of children, with approximately 12-20% of fractures caused by abuse. While the literature has described fracture patterns that should prompt a child abuse evaluation, little is known about the characteristics of the emergency department (ED) encounters themselves (e.g., time of day, day of week) and associated patient demographics among children for whom a child abuse pediatrician (CAP) consult is obtained. The objective of this study was to describe ED encounter arrival and disposition characteristics and demographics of children ages 0-5 years presenting to a tertiary pediatric ED with fractures who did and did not have a CAP consult.
This study was part of a larger retrospective observational study of 2,991 patients aged 0-5 with an ED discharge diagnosis including fracture who were seen in a regional tertiary pediatric ED in New England between January 2014 and December 2021.This institutional dataset includes all ED-encounter full-text clinician notes, radiology reports, and discrete variables (e.g., demographics, ICD-9/10 codes, triage acuity). Descriptive analyses of ED encounter arrival and disposition characteristics, patient demographics, and presence of a CAP consultation were completed.
There were 2,991 unique patient encounters for fractures during the study period, of which 193 (6.5%) had a completed CAP consult. Compared to children without a CAP consult, children who had a CAP consult had proportionately fewer weekend presentations (21.7% versus 31.9%) and more Monday presentations (21.8% versus 14.3%), a higher proportion of visits between 11p-7a (17.1% versus 8.7%), and a higher proportion of more acute triage ESI designations (68.9% ESI 2 versus 35.0% ESI 2). 86% of ED encounters with a CAP consult resulted in an admission, versus 9.9% of visits without a consult. Children with a CAP consult had a lower median age (0.5 years, IQR 1.2 versus 3.3 years, IQR 2.8), with a higher proportion of children identified as Black race (11.4% vs 8.5%) and with government insurance (45.0% vs 35.9%).
We found distinct ED encounter arrival temporal patterns for children with fractures who had a CAP consult, namely an increased proportion of visits on Mondays and decreased proportion of weekend visits, as well as an increased proportion of visits overnight. There was a higher proportion of more acute triage ESI designations and a higher proportion of admissions compared to children without a consult. Patient demographic trends were similar to prior publications about abusive injuries. These ED temporal patterns should be further studied to understand why they occur and may inform the development of child abuse prediction models.
1. Fractures are a common childhood injury and up to 20% may be due to abuse.
2. Children who had a child abuse pediatrics consultation had a lower mean age and a higher proportion of more acute emergency severity index triage designations.
3. A higher proportion of children with fractures who had a child abuse pediatrics consultation were seen on Mondays and on the overnight shift compared to those without a consultation.