Indicators of Non-accidental Trauma in Patients Under 24 Months of Age

Emergency department medical staff should be cautious of trauma patients who present with any of thesevariables found to be associated with NAT. Identification of NAT on the first presentation by medical staff may prevent victims of NAT from facing subsequent abuse, fatality, or lifelong complications

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The importance of surgeon involvement in the evaluation of non-accidental trauma patients

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2013.03.035 ◽

2013 ◽

Vol 48 (6) ◽

pp. 1357-1362 ◽

Cited By ~ 27

Author(s):

Emily L. Larimer ◽

Sara C. Fallon ◽

Jaimee Westfall ◽

Mary Frost ◽

David E. Wesson ◽

...

Keyword(s):

Trauma Patients ◽

Accidental Trauma ◽

Non Accidental Trauma

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Paediatric femur fractures—the value of contextual information on judgement in possible child abuse cases: are we bias?

European Journal of Pediatrics ◽

10.1007/s00431-020-03704-6 ◽

2020 ◽

Vol 180 (1) ◽

pp. 81-90

Author(s):

Marie-Louise H. J. Loos ◽

Wies M. Allema ◽

Roel Bakx ◽

Reinoud D. Stoel ◽

Rick R. van Rijn ◽

...

Keyword(s):

Emergency Department ◽

Low Income ◽

Work Experience ◽

Healthcare Professionals ◽

Contextual Information ◽

Current Function ◽

Accidental Trauma ◽

Staff Members ◽

Femur Fractures ◽

Non Accidental Trauma

AbstractThe majority of paediatric femur fractures result from accidental trauma; however, it is important to consider non-accidental trauma, especially in pre-ambulatory children. We study whether irrelevant contextual information subconsciously influences conclusions of healthcare professionals with respect to whether observations provide evidence for non-accidental trauma. A survey with nine radiographs of femur shaft fractures was designed. Two different clinical histories (vignettes) with contextual information were designed, non-abuse versus abuse context. One of both vignettes was randomly assigned to the radiograph shown to the participant, followed by a question with a 5-point answer scale, which represents a verbal expression of the likelihood ratio of the fracture regarding a non-accidental versus accidental cause. Participants were medical residents and staff members of different specialties from several Dutch hospitals. A total of 172 participants responded. The reported evidential strength of the vignettes with a non-abuse context was 0.19 (n = 784; 95%CI 0.10–0.28) and for the abuse context 0.94 (n = 764; 95%CI 0.86–1.02; p < 0.001). Women reported a stronger evidential strength than men, but both were influenced by context. Emergency department and paediatric doctors were more likely to decide that non-accidental trauma was the cause; paediatric radiologists were the least likely. Experience in years of practice and current function did not prevent participants from being bias.Conclusion: This study shows that the interpretation of medical results by healthcare professionals can be influenced by contextual information, such as low income and marital status, which are irrelevant to the decision as to whether abuse might have occurred. Given the same information about an injury, women, emergency department and paediatric doctors were more likely to decide that non-accidental trauma was the cause, while paediatric radiologists were least likely to decide this outcome. It is important to prevent contextual influence as much as possible, by recognizing it and implementing a management contextual information procedure. What is Known:• Contextual information is of possible influence on healthcare professionals in identifying non-accidental trauma.• Increased working experience is thought to be protective against this influence. What is New:• Contextual information influenced the interpretation of medical results by healthcare professionals regardless of work experience.• The interpretation of medical results by healthcare professionals is influenced by both affirmative and negative contextual information.

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Improving Evidence-Based Non-Accidental Trauma Screening in a Pediatric Emergency Department

10.1542/peds.147.3_meetingabstract.153 ◽

2021 ◽

Author(s):

Roselyn Appenteng ◽

Heather Williams ◽

Emily Fain ◽

Barron Frazier ◽

Christopher Daly ◽

...

Keyword(s):

Emergency Department ◽

Pediatric Emergency ◽

Evidence Based ◽

Pediatric Emergency Department ◽

Accidental Trauma ◽

Non Accidental Trauma

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Impact of 24/7 Onsite Emergency Radiology Staff Coverage on Emergency Department Workflow

Canadian Association of Radiologists Journal ◽

10.1177/08465371211023861 ◽

2021 ◽

pp. 084653712110238

Author(s):

Francesco Macri ◽

Bonnie T. Niu ◽

Shannon Erdelyi ◽

John R. Mayo ◽

Faisal Khosa ◽

...

Keyword(s):

Emergency Department ◽

Major Trauma ◽

Patient Flow ◽

Interrupted Time Series ◽

Trauma Patients ◽

Linear Regression Models ◽

High Acuity ◽

Time Series Approach ◽

Comparison Series ◽

The Impact

Purpose: Assess the impact of 24/7/365 emergency trauma radiology (ETR) coverage on Emergency Department (ED) patient flow in an urban, quaternary-care teaching hospital. Methods: Patient ED visit and imaging information were extracted from the hospital patient care information system for 2008 to 2018. An interrupted time-series approach with a comparison group was used to study the impact of 24/7/365 ETR on average monthly ED length of stay (ED-LOS) and Emergency Physician to disposition time (EP-DISP). Linear regression models were fit with abrupt and permanent interrupts for 24/7/365 ETR, a coefficient for comparison series and a SARIMA error term; subgroup analyses were performed by patient arrival time, imaging type and chief complaint. Results: During the study period, there were 949,029 ED visits and 739,796 diagnostic tests. Following implementation of 24/7/365 coverage, we found a significant decrease in EP-DISP time for patients requiring only radiographs (-29 min;95%CI:-52,-6) and a significant increase in EP-DISP time for major trauma patients (46 min;95%CI:13,79). No significant change in patient throughput was observed during evening hours for any patient subgroup. For overnight patients, there was a reduction in EP-DISP for patients with symptoms consistent with stroke (-78 min;95%CI:-131,-24) and for high acuity patients who required imaging (-33 min;95%CI:-57,-10). Changes in ED-LOS followed a similar pattern. Conclusions: At our institution, 24/7/365 in-house ETR staff radiology coverage was associated with improved ED flow for patients requiring only radiographs and for overnight stroke and high acuity patients. Major trauma patients spent more time in the ED, perhaps reflecting the required multidisciplinary management.

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