Integration of physical abuse clinical decision support at 2 general emergency departments

  • Authors
  • Bruce Rosenthal
  • Emily Heineman
  • Janet Fromkin
  • Janet Skrbin
  • Rachel Berger
  • Rudolph Richichi
  • Thomas McGinn
  • Published
  • Journal of the American Medical Informatics Association.



The study sought to develop and evaluate an electronic health record-based child abuse clinical decision support system in 2 general emergency departments.

Materials and methods

A combination of a child abuse screen, natural language processing, physician orders, and discharge diagnoses were used to identify children <2 years of age with injuries suspicious for physical abuse. Providers received an alert and were referred to a physical abuse order set whenever a child triggered the system. Physician compliance with clinical guidelines was compared before and during the intervention.


A total of 242 children triggered the system, 86 during the preintervention and 156 during the intervention. The number of children identified with suspicious injuries increased 4-fold during the intervention (P < .001). Compliance was 70% (7 of 10) in the preintervention period vs 50% (22 of 44) in the intervention, a change that was not statistically different (P = .55). Fifty-two percent of providers said that receiving the alert changed their clinical decision making. There was no relationship between compliance and provider or patient demographics.


A multifaceted child abuse clinical decision support system resulted in a marked increase in the number of young children identified as having injuries suspicious for physical abuse in 2 general emergency departments. Compliance with published guidelines did not change; we hypothesize that this is related to the increased number of children identified with suspicious, but less serious injuries. These injuries were likely missed preintervention. Tracking compliance with guidelines over time will be important to assess whether compliance increases as physician comfort with evaluation of suspected physical abuse in young children improves.

  • Keywords
  • Child maltreatment
  • Electronic Health Record
  • pediatric