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Referrals to Child Protective Services for pediatric emergency department patients after falls.

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Title: Referrals to Child Protective Services for pediatric emergency department patients after falls.
Authors: Shapiro, Joseph P.1 (AUTHOR) joseph.shapiro@childrensnational.org, Pino, Elizabeth C.2 (AUTHOR) Elizabeth.pino@bmc.org, Dholakia, Ayesha3 (AUTHOR) Ayesha.Dholakia@childrens.harvard.edu, Goodridge, Annie4 (AUTHOR) goodrida@bu.edu, Nelson, Kerrie P.5 (AUTHOR) Kerrie@bu.edu, Hoch, Ariel6 (AUTHOR) Ariel.hoch@bmc.org, Kendi, Sadiqa1 (AUTHOR) skendi@childrensnational.org, Boyle, Tehnaz P.7 (AUTHOR) tehnaz.boyle@bmc.org, Kistin, Caroline J.8 (AUTHOR) caroline_kistin@brown.edu
Source: Child Abuse & Neglect. May2026, Vol. 175, pN.PAG-N.PAG. 1p.
Subject Terms: *Child abuse, Child protection services, Pediatric emergency services, Emergency medical services, Crash injuries, Children's injuries, Health equity, Home accidents
Geographic Terms: United States
Abstract: Falls are the leading cause of non-fatal childhood injury in the United States. When falls are thought to result from inadequate supervision, clinicians may refer families to Child Protective Services (CPS). However, the frequency of CPS referrals for unintentional falls and factors influencing referral decisions are unknown. To investigate characteristics of children presenting to the pediatric emergency department (PED) for unintentional falls and the relationship between patient race and referrals to CPS for supervisory neglect. Children under 5 years old evaluated at an urban academic PED for an unintentional fall between October 2015 and December 2020. We conducted a cross-sectional analysis using electronic health record diagnosis codes to identify patients. Patient demographics, fall characteristics, injuries, ED arrival method, and CPS referrals were abstracted by manual chart review. Logistic regression models evaluated associations between patient demographics and visit characteristics with CPS referral. Among 933 eligible encounters, 22 patients (2.4%) were referred to CPS. In univariate analysis, fall height > 1 m (OR = 8.77, 95% CI 3.61–21.29, p = 0.0001), fracture diagnosis (OR = 5.15, 95% CI 2.15–12.33, p = 0.003), head injury diagnosis (OR = 4.34, 95% CI 1.75–10.76, p = 0.02), and ambulance arrival (OR = 3.57, 95% CI 1.50–8.50, p = 0.05) were associated with higher odds of CPS referral. Race was not significantly associated with referral. CPS referrals after unintentional falls are associated with injury severity and fall height rather than race. Future research should examine whether these factors reflect inadequate supervision or simply injury severity. [ABSTRACT FROM AUTHOR]
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Database: Education Research Complete
Description
Abstract:Falls are the leading cause of non-fatal childhood injury in the United States. When falls are thought to result from inadequate supervision, clinicians may refer families to Child Protective Services (CPS). However, the frequency of CPS referrals for unintentional falls and factors influencing referral decisions are unknown. To investigate characteristics of children presenting to the pediatric emergency department (PED) for unintentional falls and the relationship between patient race and referrals to CPS for supervisory neglect. Children under 5 years old evaluated at an urban academic PED for an unintentional fall between October 2015 and December 2020. We conducted a cross-sectional analysis using electronic health record diagnosis codes to identify patients. Patient demographics, fall characteristics, injuries, ED arrival method, and CPS referrals were abstracted by manual chart review. Logistic regression models evaluated associations between patient demographics and visit characteristics with CPS referral. Among 933 eligible encounters, 22 patients (2.4%) were referred to CPS. In univariate analysis, fall height > 1 m (OR = 8.77, 95% CI 3.61–21.29, p = 0.0001), fracture diagnosis (OR = 5.15, 95% CI 2.15–12.33, p = 0.003), head injury diagnosis (OR = 4.34, 95% CI 1.75–10.76, p = 0.02), and ambulance arrival (OR = 3.57, 95% CI 1.50–8.50, p = 0.05) were associated with higher odds of CPS referral. Race was not significantly associated with referral. CPS referrals after unintentional falls are associated with injury severity and fall height rather than race. Future research should examine whether these factors reflect inadequate supervision or simply injury severity. [ABSTRACT FROM AUTHOR]
ISSN:01452134
DOI:10.1016/j.chiabu.2026.107988