O3195: Using a Standardized Screening Tool to Prompt Child Abuse Evaluation: Does Racial/ethnic Bias Still Exist?

Background: Child maltreatment remains a persistent problem throughout the world. According to the National Child Abuse and Neglect Data System (NCANDS), the largest demographics of perpetrators are White (48.9%), African American (21.1%) and Hispanic (19.7%). However, minorities are more likely to be evaluated and reported for suspected abuse. Studies have shown that implementing universal child abuse screening in the PED can increase early abuse detection. Studies are limited on whether implementing a standardized screening tool reduces racial/ethnic disparities. The main objective is to determine if racial or ethnic disparities exist in screening despite implementation of a universal screening tool.

Methods: A validated child abuse screening tool was implemented into the electronic health record system at a level 1 pediatric trauma center. This tool triggers a nursing task to complete a form which if positive sends an alert to providers that the child may be at increased risk for child abuse. While the task to complete the screen automatically fires on every patient under 11 years, there is no hard stop to ensure it is completed prior to patient discharge. A retrospective analysis and chart review was performed to assess if there were any disparities between screened and unscreened patients. Post-hoc comparisons of 27,347 children were done using chi-square tests of independence to determine if racial/ethnic bias exists. Secondary analysis evaluated disparities in further evaluation of positive screens: social work consult, report to DCS, skeletal survey or head CT obtained.

Results: All patients under 11 years old that presented to the emergency department were included in the study. Hispanic or Latino patients were less likely to be screened than Non-Hispanic or Latino patients [68.8% vs 75.4% (p < 0.001)]. White patients were more likely to be screened than Black or African American patients [75.6% vs 69.3% (p < 0.001). Asian patients were more likely to be screened than White or Black/African American patients [79.9% vs 75.6% vs 69.3% (p < 0.01 and p < 0.001 respectively)]. There was no statistically significant difference in positive screens based on ethnicity or race. Evaluation after positive screen showed no significant difference by race; however, increased reporting to DCS (p=0.0012) and social work consult (p=0.00472) were found in non-Hispanic patients.

Conclusion: Despite universal standardized screening tool, racial and ethnic disparities do exist when screening for child abuse; although, apart from Asian patients, minorities were less likely to be screened. There was no significant difference in positive screens based on race or ethnicities. Further studies are needed to determine why non-minorities are more likely to be screened than minorities. There is a significant association between both social work consultation & report made to CPS and ethnicity. Non-Hispanic patients were significantly associated with receiving social work consultation and reported to DCS.