Emergency department overcrowding and child physical abuse evaluations at a tertiary pediatric hospital.

BACKGROUND

Overcrowding in the Emergency Department (ED) can result in lower care quality. Lack of time can be a barrier to recognition of child physical abuse. Pediatric patients with abusive injuries may not be identified as frequently in an overcrowded ED.

OBJECTIVE

This study sought to evaluate correlation of ED overcrowding and child abuse concerns.

PARTICIPANTS AND

SETTING

This is a retrospective chart review for tertiary pediatric ED encounters between January 1, 2019, and June 30, 2023.

METHODS

Analyses compare ED overcrowding metrics, including the modified National Emergency Department Overcrowding Score (mNEDOCS), length of stay, rates of patients who left without being seen, and patient volumes, with the proportion of ED visits in children <18 years with Child Protective Services (CPS) reports for physical abuse, skeletal surveys (SS), or child protection team (CPT) consults.

RESULTS

Increasing ED overcrowding for 310,512 ED encounters were negatively correlated with the proportion of ED visits with CPS reports, SS, and inpatient CPT consults, with rho ranging from -0.1 to -0.21, all p > 0.001. There was no difference in ages or dispositions of patients with abuse concerns during days in the highest and lowest quartiles of mNEDOCS. The COVID-19 timeframe had lower ED volumes but higher proportion of visits with child abuse concerns.

CONCLUSIONS

More crowding in the ED was associated with a lower proportion of ED visits with CPS reports, SS, or completed CPT consults, indicating potential missed abuse during busy times. Efforts to standardize physical abuse evaluations may reduce variability during overcrowding.