Development of an electronic medical record-based child physical abuse alert system
Berger RP, Saladino RA, Fromkin J, Heineman E, Suresh S, McGinn T. Development of an electronic medical record-based child physical abuse alert system. Journal of the American Medical Informatics Association. 2017; 25(2), 142-149. doi:10.1093/jamia/ocx063.
Objective: Physical abuse is a leading cause of pediatric morbidity and mortality. Physicians do not consistently screen for abuse, even in high-risk situations. Alerts in the electronic medical record may help improve screen-ing rates, resulting in early identiﬁcation and improved outcomes.
Methods: Triggers to identify children < 2 years old at risk for physical abuse were coded into the electronic medical record at a freestanding pediatric hospital with a level 1 trauma center. The system was run in “silent mode”; physicians were unaware of the system, but study personnel received data on children who triggered the alert system. Sensitivity, speciﬁcity, and negative and positive predictive values of the child abuse alert sys-tem for identifying physical abuse were calculated.
Results: Thirty age-speciﬁc triggers were embedded into the electronic medical record. From October 21, 2014, through April 6, 2015, the system was in silent mode. All 226 children who triggered the alert system were con-sidered subjects. Mean (SD) age was 9.1 (6.5) months. All triggers were activated at least once. Sensitivity was 96.8% (95% CI, 92.4–100.0%), speciﬁcity was 98.5% (95% CI, 98.3.5–98.7), and positive and negative predictive values were 26.5% (95% CI, 21.2–32.8%) and 99.9% (95% CI, 99.9–100.0%), respectively, for identifying chil-dren < 2 years old with possible, probable, or deﬁnite physical abuse.
Discussion/Conclusion: Triggers embedded into the electronic medical record can identify young children with who need to be evaluated for physical abuse with high sensitivity and speciﬁcity.