Child Maltreatment Evaluations Following Out-of-Hospital Cardiac Arrests

Sabrina M Darwiche; Cindy W Christian; Cody-Aaron L Gathers; Ryan W Morgan; Maryam Y Naim; Joanne N Wood

doi:10.1016/j.acap.2025.102777

Child Maltreatment Evaluations Following Out-of-Hospital Cardiac Arrests

Acad Pediatr. 2025 Jan 9:102777. doi: 10.1016/j.acap.2025.102777. Online ahead of print.

Authors

Sabrina M Darwiche¹, Cindy W Christian², Cody-Aaron L Gathers³, Ryan W Morgan⁴, Maryam Y Naim⁴, Joanne N Wood⁵

Affiliations

¹ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Safe Place and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: darwiches@chop.edu.
² Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
³ Safe Place and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
⁴ Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
⁵ Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Safe Place and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

PMID: 39798786
DOI: 10.1016/j.acap.2025.102777

Abstract

Objectives: In children admitted after an out-of-hospital cardiac arrest (OHCA), this study 1) determines the proportion that undergo: physical abuse and toxin exposure evaluation, child protection team (CPT) consultation, and child protective services (CPS) referral, and 2) evaluates the association between demographic, social, clinical characteristics with CPT consultation and CPS referral.

Methods: Retrospective chart review was conducted of children < 4 years old admitted following an OHCA between November 2012 and February 2023. Associations between demographics, caregiver social risk factors, and clinical characteristics with CPT consultation and CPS referral were examined using logistic regression.

Result: Among 157 cases, 70 (45%) had skeletal surveys; eight (11%) identified an occult fracture. Seventy-five (48%) children had toxicology testing; Sixteen of the 75 (21%) revealed a toxic ingestion. Sixteen of the 49 (33%) patients receiving ophthalmologic evaluations had significant retinal hemorrhages. Seventy-seven (49%) patients had a CPT consultation, while 74 (47%) were referred to CPS. A history concerning for ingestion perfectly predicted CPT consultation. History of ingestion, injury on exam, positive skeletal survey, and positive toxicology testing perfectly predicted CPS referral. In multivariate analyses, unsafe sleep history (84% versus 41%, p<0.001) and caregiver social risk factors (82% versus 31%, p<0.001) were associated with CPT consultation, while caregiver social risk factors (70% versus 34%, p<0.001) and normal medical work-up (53% versus 38%, p=0.050) were associated with CPS referral.

Conclusions: Following OHCA, a child maltreatment evaluation may be underutilized with medical decision-making around CPT consultation and CPS referral driven by knowledge of caregiver social risk factors.

Keywords: cardiac arrest; child maltreatment; child protective services; disparities.