Work

Evaluating bias of child maltreatment referrals in encounters for unintentional ingestions

Year: 2024

Type: article

Abstract: Background Unintentional ingestions commonly result in presentation to the pediatric emergency department (PED). No standardized recommendations exist regarding when to call Child Protective Services (CPS) for unintentional ingestions, which allows for the possibility of biased decision-making. Objective Identify patient and visit level characteristics associated with CPS referral status in unintentional ingestion encounters. Participants and Setting Retrospective cross-sectional study of children ≤6 years old presenting with unintentional ingestion to a metropolitan PED from 2015 to 2021. Methods ICD-10-CM codes were used to identify unintentional ingestion visits in the electronic health record . CPS referral was determined by manual chart review. Bivariable and multivariable logistic regression models identified patient and visit level characteristics associated with CPS referral. Socioeconomic status (SES) was classified based on zip code, the Child Opportunity Index data, and insurance. Results Of 3,836 charts reviewed, 808 met inclusion criteria. CPS referrals were made in 109 (13.5%) visits. Compared to non-Hispanic white patients, non-Hispanic Black patients had 7.37 (95% CI:1.38, 39.26) higher adjusted odds of being referred to CPS after adjusting for triage level, age, and ingestion type. Patients in the Lowest SES group had a 3.01 (95% CI:1.42, 6.40) higher adjusted odds when compared to the Middle/Highest SES group. Conclusion This study found that CPS referrals in unintentional ingestions occur more often in those identifying as non-Hispanic Black and in those in the Lowest SES group, suggesting clinician bias may impact the decision regarding referrals. To mitigate subjective decision-making, we propose creating standardized, objective CPS referral criteria for unintentional ingestions.

Source: Child Protection and Practice

DOI: 10.1016/j.chipro.2024.100077

Authors: Gabriella Giugliano, Danae L. Massengill, Gia Badolato, Xian Zhao

Institutions: Children's National, University of Pittsburgh, Denver Health Medical Center, George Washington University

Language: English

Topic: Child Abuse and Related Trauma

Subfield: Pediatrics, Perinatology and Child Health

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $2,200