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 reports 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 following settings: pediatric emergency department (PED) (50%), general emergency department (GED) (30%), PED and GED (9%), and outpatient clinic (11%). Inpatient 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 23% 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 inadequate information was available at the time of the acute visit to file a SCAN report. Compared with admissions from a PED, a higher percent of admissions from a GED had inpatient reports without additional findings after the acute care evaluation (P<0.05). Seventy-five percent of patients in whom no additional information was obtained during the admission required admission to an intensive care unit (ICU) setting. Forty-eight percent (21 of 44) of inpatient SCAN reports were determined substantiated following Child Protective Services (CPS) investigation. Forty-two percent (10 of 24) of those cases 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 PED had inpatient reports of SCAN without additional findings. Patients who have an inpatient report filed for SCAN are often of high medical acuity, less likely to have physical findings, and may present with injuries or illnesses unrelated to the SCAN.