Professor, Pediatrics Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania, United States
Background: Pediatric out-of-hospital cardiac arrests (OHCAs) are associated with high morbidity and mortality rates with nearly half having an undetermined etiology. While child maltreatment is a recognized cause, little is known regarding the frequency and results of child maltreatment evaluations in this population. Objective: Following an OHCA: 1) determine the rate and results of child maltreatment evaluations (toxicology testing, skeletal survey performance, social work psycho-social assessment, child protection team [CPT] consult), 2) determine the rate of child protective services (CPS) reports, and 3) evaluate the association between demographic, social, and clinical characteristics with CPT consult and CPS referral. Design/Methods: We conducted a chart review of patients < 4 years old evaluated at a tertiary care center between 2012-2023 following an OHCA. Subjects were identified through a hospital database of children receiving care after a cardiac arrest in which CPR was delivered. We examined associations of demographic (age, race, insurance), social risk factors (caregiver substance use, mental health history, law enforcement or CPS history, housing instability), and clinical characteristics (pre-existing medical conditions, history provided, physical exam findings, and laboratory evaluation) with the outcomes of CPT consult and CPS referral using chi-square tests. Significant covariates in bivariate analyses were included in logistic regressions models. Results: Among 197 cases of OHCA, 98 (50%) were < 12 months old. Skeletal surveys were performed in 56% (55/99) of infants, of which 15% (8/55) had newly identified fractures. Skeletal surveys were performed in 17% (9/53) of children 12-24 months; none identified new fractures. Seventy-six (39%) children had toxicology testing, amongst which 17 (22%) revealed a toxic ingestion. Social work completed a psychosocial assessment in 50% (99/197) of cases. Seventy-nine (40%) patients had a CPT consult and 74 (38%) had a CPS report filed. In multivariable analyses, unsafe sleep history [OR 10.3, 1.7-63.3], lack of preexisting medical conditions [OR 3.0, 1.1-8.5], and social risk factors [OR 16.4, 6.2-43.4] were associated with CPT consult, while trauma [OR 3.0, 1.1-7.9 ] or ingestion [OR 21.29, 1.7-261.5] history, and social factors [OR 5.6, 2.5-12.1] were associated with a CPS report.
Conclusion(s): Following an OHCA, evaluation for maltreatment is performed in a minority of cases and is associated with the presence of social risk factors. This suggests the need for a standardized approach to minimize the risk of bias influencing medical decision-making.
