Inpatient reports of suspected child abuse or neglect (SCAN): A question of missed opportunities in the acute care setting

Objective: To determine reasons inpatient reports of suspected child abuse or neglect (SCAN) were not initiated at the time of evaluation in the acute care setting. Design: Retrospective case series, Setting: Urban children's hospital. Patients: Forty-four children with repo rts of SCAN filed as hospital inpatients between January 1 and December 31, 1993, Interventions: None. Results: Prior to admission, the 44 patients were evaluated in the followin g settings: pediatric emergency department (PED) (50%, general emergency de partment(GED) (30%), FED and GED (9%), and outpatient clinic (11%). Inpatie nt reports were more often for suspicion of neglect than for physical abuse , when compared to reports made in the ambulatory setting (P < 0.001). In 2 3% of cases, the injury or illness necessitating admission. was not related to the SCAN. Mean delay in filing a SCAN report following admission was 2. 7 days (range 0-20 days). In 45% of cases, it was determined that inadequat e information was available at the time of the acute visit to file a SCAN r eport, Compared with admissions from FED, a higher percent of admissions fr om a GED had inpatient reports without additional findings after the acute case evaluation (P < 0.05), Seventy-five percent of patients in whom no add itional information was obtained during the admission required admission to an intensive care unit (ICU) setting. Forty-eight percent (21 of 44) of in patient SCAN reports were determined substantiated following Child Protecti ve Services (CPS) investigation. Forty-two percent (10 of 24) of those case s in which no additional information was uncovered following admission were determined substantiated. Conclusions: Inpatient reports are often the result of additional findings obtained after admission, A higher percentage of admissions from a GED than from a FED had inpatient reports of SCAN without additional findings, Pati ents who have an inpatient report filed for SCAN are often of high medical acuity, less likely to have physical findings, and may present with injurie s or illnesses unrelated to the SCAN.