Background
Child maltreatment is a leading cause of death and disability in children in the United States. More than 3 million reports to Child Protective Services (CPS) are made every year in the US. In 2019, over 1,800 children died of child maltreatment; this is more children than died from influenza, respiratory syncytial virus (RSV) and COVID combined. The number of children dying due to maltreatment has increased 11% over the past 5 years suggesting that current efforts to protect children are insufficient. The long-term costs of child maltreatment cannot be underestimated. Children who have been maltreated often have lifelong adverse health, social, and economic consequences.
Accurate and timely recognition of the early signs of child maltreatment is critical to decreasing morbidity and mortality. This is especially true for young children who are victims of child physical abuse. A significant proportion of children who suffer severe morbidity and/or mortality due to physical abuse had been previously evaluated by physician(s) who did not recognize the abuse.
Despite evidence-based recommendations from the American Academy of Pediatrics (AAP), medical providers fail to consistently screen for and evaluate for abuse even in high-risk situations. Studies have also shown persistent and pervasive disparities in screening practices related to patient race and socioeconomic status and hospital characteristics. Data suggest that ongoing efforts at education of providers have not been successful.
Data collected over the past 7 years suggests that embedding child abuse-clinical decision support (CA-CDS) into the electronic health record (EHR) can help to improve identification, evaluation and reporting of suspected maltreatment while mitigating racial disproportionality. The CA-CDS consortium was founded to ensure that there is a cohesive, well-coordinated multi-disciplinary approach to CA-CDS integration and dissemination.
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