Accidental Toxicological Pediatric Ingestions: Disparities in the Involvement of Social Work and Child Protective Services.

OBJECTIVES

To examine sociodemographic and clinical factors associated with social work consultation and child protective services (CPS) referrals among children presenting to the pediatric emergency department (ED) after an accidental toxicological ingestion.

METHODS

This retrospective study included children ≤5 years of age presenting to the ED between January 1, 2021, and December 31, 2023, with a diagnostic code for poisonings. Demographic and clinical variables were recorded, and clinical severity was quantified using 2 complementary scores. Predictor variables include race, ethnicity, language, insurance, serum drug screen and urine drug screen (UDS) results, prior CPS involvement, clinical severity on presentation, and critical interventions. The primary outcome was social work involvement, while the secondary outcome was a CPS referral. Unadjusted odds ratios (OR) with 95% CI were calculated.

RESULTS

Among 569 patients, social work was involved in 26.5% (n=151) of cases, and CPS was contacted for 17.8% (n=101). Children who were Black (OR: 2.08, 95% CI: 1.38-3.13, P=0.0005), had public insurance (OR: 2.87, 95% CI: 1.59-5.22, P=0.0003), a positive UDS (OR: 17.79, 95% CI: 7.49-42.22, P<0.0001), or critical/fatal clinical severity (OR: 24.92, 95% CI: 9.55-65.05, P<0.0001) were more likely to have social work consultation. These children were also more likely to have a CPS referral.

CONCLUSIONS

Race, insurance status, a positive UDS, and clinical severity were associated with social work consultation and CPS referrals among young children presenting to the ED following an accidental ingestion. Evidence-based referral guidelines are needed to promote consistent and equitable decision-making.