Background: Previous studies show contradictory findings regarding the significance of prior healthcare visits as a red flag for physical child abuse. We aimed to compare prior healthcare visits of physically abused children with those of accidentally injured children.
Methods: A retrospective case control study compared prior injury and non-injury related visits of physically abused and accidentally injured children presenting to Soroka University Medical Center Emergency Department (ED) during 2008-2013. Variables analyzed included injury and non-injury related visits to ED and community clinics during 6 months, 1 and 3 years before the index visit and from birth.
Results: 146 physically abused children were compared to 48,796 accidentally injured children. Multivariate modelling controlling for potential confounders demonstrated that more abused children than control subjects had prior injury-related ED visits during the 6 months (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.97-4.44), 1 year (OR 1.88, 95% CI 1.35-2.61) and 3 years (OR 1.52, 95% CI 1.20-1.93) preceding the index visits and from birth (OR 1.26, 95% CI 1.01-1.57). Non-injury related ED visits were more frequent amongst abused children during the 6 months (OR 1.40, 95% CI 1.22-1.61), 1 year (OR 1.21, 95% CI 1.10-1.33) and 3 years (OR 1.05, 95% CI 1.01-1.08) preceding the index visits and from birth (OR 1.02, 95% CI 1.00-1.05). Differences in patterns of community healthcare visits were not clinically significant; however 66.4% of abused children had visited community clinics during 6 months before abuse identification.
Conclusions: Prior ED visits, especially injury-related or recent ones, could serve as a red flag for physical child abuse.
