Rangel 2009


Year: 2009

Title: Eliminating disparity in evaluation for abuse in infants with head injury: use of a screening guideline

Country: United States

Age: Pediatric Only

Sex: All Sexes

Population: Black

Care Setting: Emergency Department

Clinical Setting: NAT

Data Level: Single Institution

Data Type: EHR

Data Source: Local data

Conclusion: Disparities In All Minority Groups

Health OutComes Reported: Yes

Mitigation: Yes

Free Text Conclusion: Black children with unwitnessed head trauma were more likely to be screened for NAT but this was fully mitigated by a screening guideline. Positive skeletal surveys did not differ by race.

Abstract: PURPOSE: Minority and disadvantaged children are evaluated for nonaccidental trauma (NAT) at higher rates than other children. At our institution, we implemented a guideline to perform skeletal surveys to screen for occult fractures in all infants with unwitnessed head injury (UHI). The goal was to determine if this guideline decreased disparities in the screening of African American (AA) and uninsured children. PATIENTS AND METHODS: For 54 months, rates of skeletal surveillance and abuse determination were compared between AA and white infants admitted with UHI before and after implementation of our guideline. Logistic regression was used to control for confounders. RESULTS: Before the guideline, AAs underwent skeletal surveillance more than whites (n = 208; 90.5% vs 69.3%; P = .01), with 20% of screened infants determined to be probable victims of NAT. Whites with private insurance were less likely to be screened compared to those without private insurance (50.0% vs 88.1%; P < .001). After the guideline, AA and whites were surveyed equally (n = 52; 92.3% vs 84.6%; P = 1.0), with 22% found to be probable cases of NAT. CONCLUSIONS: This is the first report of a successful policy-based intervention to decrease disparity in care. The maintenance of a stable rate of NAT determination despite increased screening suggests more victims of abuse may be identified with guideline use, and therefore, this may be an additional benefit of the guideline.