Abstract
Significance of problem: The rise in the number of pediatric patients seen for abuse is alarming.1 More than 7 million reports for maltreatment were made to Child Protective Services in 2021.2 Rates of reported abuse were 8.1 per 1000, with 16% of these identified as non-accidental trauma (NAT) and the greater incidence happening to those 1 year or younger.3,4 One to two deaths per day are attributed to NAT in the US.5 System improvements in emergency rooms (ER) and hospitals, such as implementing screening tools or protocols, are crucial for early detection and prevention of NAT.6,7
Clinical project purpose: This project implemented a brief, validated, NAT screening tool to detect abuse or neglect in pediatric patients evaluated within a rural ER setting. The project’s goal was to provide timely care and prevent further harm.
Clinical appraisal of literature/Best evidence: Two studies suggested that a brief and easy-to-use screening protocol should be implemented to produce the most results in identifying NAT.7,8 After one hospital implemented a brief screening protocol along with staff education, the compliance rate rose from 56% to almost 96%.9
Integration into practice: The Screening Instrument for Child Abuse and Neglect (SCAN) tool is a validated tool that provides a brief 4-item questionnaire to screen all children for abuse.10 The SCAN tool was implemented in a rural ER in southern Indiana for all children evaluated for care, regardless of admitting diagnosis. Pre- and post-surveys were given to staff to evaluate their knowledge and feelings about using a screening tool for pediatric NAT. The number of screenings and identification of NAT for the 6 months studied was compared to the previous 6 months without the use of the screening tool.
Nursing Implications: Nurses play a central role in proactively identifying NAT, being able to quickly and effectively screen patients, and contacting authorities for further evaluation and intervention. Using validated screening tools and protocols will facilitate this process and ensure all pediatric patients seen for care in the ER setting will be evaluated.
Notes
References:
1. McTavish, J. R., Gonzalez, A., Santesso, N., MacGregor, J. C. D., McKee, C., & MacMillan, H. L. (2020). Identifying children exposed to maltreatment: A systematic review update. BMC Pediatrics, 20(1), 113. https://doi.org/10.1186/s12887-020-2015-4
2. Child Welfare Information Gateway. (2023). Child maltreatment 2021 summary. https://www.childwelfare.gov/resources/child-maltreatment-2021-summary/
3. U. S. Department of Health and Human Services. (2021). Child maltreatment 2021. https://www.acf.hhs.gov/cb/report/child-maltreatment-2021
4. Appenteng, R., Williams, H., Fain, E., Frazier, B., Daly, C., Phillips, A., Boudreaux, D., Greeno, A., Danko, M., & Johnson, D. P. (2021). Improving evidence-based non-accidental trauma screening in a pediatric emergency department. Council on Quality Improvement and Patient Safety Program.
https://doi.org/10.1542/peds.147.3_meetingabstract.153
5. Schermerhorn, S. M. V., Muensterer, O. J., & Ignacio, R. C. Jr. (2024). Identification and evaluation of non-accidental trauma in the pediatric population: A clinical review. Children (Basel, Switzerland), 11(4), 413. https://doi.org/10.3390/children11040413
6. Reid, M., & Snyder, C. (2021). Feasibility of using child maltreatment measurement instruments in the primary care setting: A systematic review. Journal of Pediatric Nursing, 61, e1–e14. https://doi.org/10.1016/j.pedn.2021.04.002
7. Crichton, K. G., Cooper, J. N., Minneci, P. C., Groner, J. I., Thackeray, J. D., & Deans, K. J. (2016). A national survey on the use of screening tools to detect physical child abuse. Pediatric Surgery International, 32(8), 815-818. https://doi.org/10.1007/s00383-016-3916-z
8. Chen, C. J., Chen, Y. W., Chang, H. Y., & Feng, J. Y. (2022). Screening tools for child abuse used by healthcare providers: A systematic review. The Journal of Nursing Research: JNR, 30(1), e193. https://doi.org/10.1097/JNR.0000000000000475
9. Dudas, L., Petrohoy, G., Esernio-Jenssen, D., Lansenderfer, C., Stirparo, J., Dunstan, M., & Browne, M. (2019). Every child, every time: Hospital-wide child abuse screening increases awareness and state reporting. Pediatric Surgery International, 35(7), 773–778. https://doi.org/10.1007/s00383-019-04485-2
10. Hoedeman, F., Puiman, P. J., van den Heuvel, E. A. L., Affourtit, M. J., Bakx, R., Langendam, M. W., van de Putte, E. M., Russel-Kampschoer, I. M. B., Schouten, M. C. M., Teeuw, A. H., de Koning, H. J., & Moll, H. A. (2023). A validated screening instrument for child abuse and neglect (SCAN) at the emergency department. European Journal of Pediatrics, 182(1), 79–87. https://doi.org/10.1007/s00431-022-04635-0
Sigma Membership
Omicron Psi
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Instrument and Tool Development, Acute Care, Policy and Advocacy, Clinical Practice, Promoting Clinical Outcomes, Pediatric Patients, Abuse or Neglect in Pediatric Patients, Rural Area, Emergency Department
Recommended Citation
Schroering, Allison Louise; Carter, Ashley N.; and Hand, Mikel W., "Use of Screening Tool for Pediatric Non-Accidental Trauma in a Rural Emergency Room Setting" (2025). Biennial Convention (CONV). 55.
https://www.sigmarepository.org/convention/2025/posters_2025/55
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-12-04
Use of Screening Tool for Pediatric Non-Accidental Trauma in a Rural Emergency Room Setting
Indianapolis, Indiana, USA
Significance of problem: The rise in the number of pediatric patients seen for abuse is alarming.1 More than 7 million reports for maltreatment were made to Child Protective Services in 2021.2 Rates of reported abuse were 8.1 per 1000, with 16% of these identified as non-accidental trauma (NAT) and the greater incidence happening to those 1 year or younger.3,4 One to two deaths per day are attributed to NAT in the US.5 System improvements in emergency rooms (ER) and hospitals, such as implementing screening tools or protocols, are crucial for early detection and prevention of NAT.6,7
Clinical project purpose: This project implemented a brief, validated, NAT screening tool to detect abuse or neglect in pediatric patients evaluated within a rural ER setting. The project’s goal was to provide timely care and prevent further harm.
Clinical appraisal of literature/Best evidence: Two studies suggested that a brief and easy-to-use screening protocol should be implemented to produce the most results in identifying NAT.7,8 After one hospital implemented a brief screening protocol along with staff education, the compliance rate rose from 56% to almost 96%.9
Integration into practice: The Screening Instrument for Child Abuse and Neglect (SCAN) tool is a validated tool that provides a brief 4-item questionnaire to screen all children for abuse.10 The SCAN tool was implemented in a rural ER in southern Indiana for all children evaluated for care, regardless of admitting diagnosis. Pre- and post-surveys were given to staff to evaluate their knowledge and feelings about using a screening tool for pediatric NAT. The number of screenings and identification of NAT for the 6 months studied was compared to the previous 6 months without the use of the screening tool.
Nursing Implications: Nurses play a central role in proactively identifying NAT, being able to quickly and effectively screen patients, and contacting authorities for further evaluation and intervention. Using validated screening tools and protocols will facilitate this process and ensure all pediatric patients seen for care in the ER setting will be evaluated.
Description
Pediatric non-accidental trauma is a growing problem, with the highest rates reported in those less than 1 year old. Early detection via emergency room screening tools is essential. This project introduced the Screening Instrument for Child Neglect tool, a 4-item questionnaire, in a rural Indiana emergency room to identify abuse in all pediatric patients. The incidence of positive findings during the 6-month survey period will be discussed along with staff perceptions of the use of the tool.