PDF(Pubmed)
Abstract：
OBJECTIVE: Physical abuse is a significant cause of morbidity and mortality for children. Routine screening by emergency nurses has been proposed to improve recognition, but the effect on emergency department (ED) workflow has not yet been assessed. We sought to evaluate the feasibility of routine screening and its effect on length of stay in a network of general EDs.
METHODS: A 2-question child physical abuse screening tool was deployed for children <6 years old who presented for care in a system of 27 general EDs. Data were compared for the 6 months before and after screening was deployed (4/1/2019-10/2/2019 vs 10/3/2019-3/31/2020). The main outcome was ED length of stay in minutes.
RESULTS: There were 14,133 eligible visits in the prescreening period and 16,993 in the screening period. Screening was completed for 13,404 visits (78.9%), with 116 (0.7%) screening positive. The mean ED length of stay was not significantly different in the prescreening (95.9 minutes) and screening periods (95.2 minutes; difference, 0.7 minutes; 95% CI, -1.5, 2.8). Among those who screened positive, 29% were reported to child protective services. On multivariable analysis, implementation of the screening tool did not impact overall ED length of stay. There were no significant differences in resource utilization between the prescreening and screening periods.
CONCLUSIONS: Routine screening identifies children at high risk of physical abuse without increasing ED length of stay or resource utilization. Next steps will include determining rates of subsequent serious physical abuse in children with or without routine screening.
METHODS: A 2-question child physical abuse screening tool was deployed for children <6 years old who presented for care in a system of 27 general EDs. Data were compared for the 6 months before and after screening was deployed (4/1/2019-10/2/2019 vs 10/3/2019-3/31/2020). The main outcome was ED length of stay in minutes.
RESULTS: There were 14,133 eligible visits in the prescreening period and 16,993 in the screening period. Screening was completed for 13,404 visits (78.9%), with 116 (0.7%) screening positive. The mean ED length of stay was not significantly different in the prescreening (95.9 minutes) and screening periods (95.2 minutes; difference, 0.7 minutes; 95% CI, -1.5, 2.8). Among those who screened positive, 29% were reported to child protective services. On multivariable analysis, implementation of the screening tool did not impact overall ED length of stay. There were no significant differences in resource utilization between the prescreening and screening periods.
CONCLUSIONS: Routine screening identifies children at high risk of physical abuse without increasing ED length of stay or resource utilization. Next steps will include determining rates of subsequent serious physical abuse in children with or without routine screening.
摘要：
目的：身体虐待是儿童发病和死亡的重要原因。建议急诊护士进行常规筛查，以提高认可度，但对急诊科(ED)工作流程的影响尚未评估.我们试图评估常规筛查的可行性及其对一般ED网络中住院时间的影响。
方法：为在27个普通ED系统中接受护理的6岁以下儿童部署了一个2个问题的儿童身体虐待筛查工具。比较筛查部署前后6个月的数据（2019年4月1日至10月2日，2019年10月3日至3月31日）。主要结果是ED的停留时间，以分钟为单位。
结果：在筛选期有14,133次符合条件的访视，在筛选期有16,993次。筛查完成了13,404次(78.9%)，116（0.7%）筛查阳性。在预筛查（95.9分钟）和筛查期（95.2分钟；差异，0.7分钟；95%CI，-1.5，2.8）。在那些筛查呈阳性的人中，29%的人向儿童保护机构报告。在多变量分析中，筛查工具的实施并未影响ED的整体住院时间.在预筛选期和筛选期之间，资源利用率没有显着差异。
结论：常规筛查可在不增加ED住院时间或资源利用的情况下识别出身体虐待高危儿童。下一步将包括确定有或没有常规筛查的儿童随后严重身体虐待的发生率。
方法：为在27个普通ED系统中接受护理的6岁以下儿童部署了一个2个问题的儿童身体虐待筛查工具。比较筛查部署前后6个月的数据（2019年4月1日至10月2日，2019年10月3日至3月31日）。主要结果是ED的停留时间，以分钟为单位。
结果：在筛选期有14,133次符合条件的访视，在筛选期有16,993次。筛查完成了13,404次(78.9%)，116（0.7%）筛查阳性。在预筛查（95.9分钟）和筛查期（95.2分钟；差异，0.7分钟；95%CI，-1.5，2.8）。在那些筛查呈阳性的人中，29%的人向儿童保护机构报告。在多变量分析中，筛查工具的实施并未影响ED的整体住院时间.在预筛选期和筛选期之间，资源利用率没有显着差异。
结论：常规筛查可在不增加ED住院时间或资源利用的情况下识别出身体虐待高危儿童。下一步将包括确定有或没有常规筛查的儿童随后严重身体虐待的发生率。
