Assessing paediatric safeguarding in rural Australian health services.

Aim: Establish the incidence, burden and characteristics of paediatric safeguarding concerns in rural Australian emergency department practice.

Methods: Retrospective cohort study of burns, injury and poisoning presentations across 16 months involving 1472 paediatric cases.

Results: Five per cent of presentations had confirmed safeguarding concern. These were highest during the 2200-0600 staffing period. Mean age was 7.7 years, 43.8% were female. Multivariable regression models show age 2-6 years (odds ratio (OR), 3.27; 95% confidence interval (CI), 1.35-7.93); delayed presentation (OR, 2.3; 95% CI, 1.47-3.59); and police accompaniment (OR, 9.46; 95% CI, 2.61-34.26) are associated with increased safeguarding concerns. Most concerns (91.8%) related to injuries, largely musculoskeletal, wounds and head injuries. Thermal burns were more common than chemical and electrical.

Conclusion: Children aged 2-6 are at higher risk for harm than previously recognised and children aged 0-2 years were over-represented in staff-suspected concerns. Those accompanied by police had significant association with confirmed safeguarding concerns which were under-suspected by staff or assumed to have been already reported. In rural practice, 'unreasonable delay' was found to be a better measure of concern than a discrete time value. Transient family arrangements, unsecured accommodation, geographical isolation, cultural safety and unique home environments must be taken into when completing injury assessments. For regional health services to successfully identify children at risk, interagency collaboration, staff education and local patterns of concern should be targeted. Rostering changes should increase after-hours assessment capacity by specialty paediatric staff.