Prediction of child abuse risk from emergency department use.
OBJECTIVE
To examine whether pre-abuse rates and patterns of emergency department (ED) visits between children with supported child abuse and age-matched control subjects are useful markers for abuse risk.


METHODS
A population-based case-control study using probabilistic linkage of four statewide data sets. Cases were abused children <13 years of age, identified between January 1, 2002, and December 31, 2002. For each case, a birth date-matched, population-based control was obtained. Outcome measures were rate ratios of ED visits in cases compared with control subjects.


RESULTS
Cases (n = 9795) and control subjects (n = 9795) met inclusion criteria; 4574 cases (47%) had an ED visit; thus linked to the ED database versus 2647 control subjects (27%). The crude ED visit rate per 10,000 person-days of exposure was 8.2 visits for cases compared with 3.9 visits for control subjects. Cases were almost twice as likely as control subjects (adjusted rate ratio = 1.8; 95% CI, 1.5, 1.8) to have had a prior ED visit. Leading ED discharge diagnoses were similar for both groups.


CONCLUSIONS
Children with supported child abuse have higher ED use before abuse diagnosis, when compared with the general pediatric population. However, neither the rate of ED use nor the pattern of diagnoses offers sufficient specificity to be useful markers of risk for abuse.
Guenther
Elisabeth
E
Division of Pediatric Emergency Medicine, University of Utah Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84158, USA. elisabeth.guenther@hsc.utah.edu
Knight
Stacey
S
Olson
Lenora M
LM
Dean
J Michael
JM
Keenan
Heather T
HT
D016022:Case-Control Studies; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000706:statistics & numerical data*; D002675:Child, Preschool; D016208:Databases, Factual; D017579:Domestic Violence / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017057:Medically Uninsured; D008605:Mental Health Services / Q000706:statistics & numerical data; D018570:Risk Assessment; D014589:Utah / Q000453:epidemiology