Document Type
Poster
Publication Date
2022-7
Abstract
Children in their first year of life are most at risk of child maltreatment. Young children and infants are most at risk of fatality. Seemingly minor injuries are commonly present prior to extreme physical abuse. The most common injury to precede near-fatality and death due to child abuse is bruising that was disregarded or misdiagnosed as accidental. Bruising in children who have not started to cruise or walk is suspicious of non-accidental injury and can be predictive of abuse. The emergency department (ED) at a critical access hospital in rural Alaska does not use an evidence-based tool to assess bruises in pediatric patients. There is a lack of information about how to identify and respond to bruising that indicates further evaluation. The goal of this project is to provide ED nurses with a clinical tool and training that will help them to recognize children and infants who are at high risk for physical abuse The solution is to provide evidence-based, clinical guidance and steps to follow for a pediatric patient with a bruise that may be the result of inflicted injury. The TEN-4-FACESp bruising clinical decision rule (BCDR) is a validated tool that is 96% sensitive and 87% specific for distinguishing accidental and non-accidental bruising in young children. To reach the goal of recognizing and responding to abusive bruising in pediatric patients, an updated protocol for pediatric non-accidental injury using an algorithm has been created. ED nurses will be provided two skills training sessions in the use of a BCDR in the ED. Nurses will determine the next steps and resources if a pediatric patient in the ED has a positive finding on the BCDR. The Stetler Model of Evidence-Based Practice, focusing on how research findings are implemented into clinical practice, is the guiding framework. This project follows a step-by-step guide to applying the evidenced-based, validated BCDR in the ED and adapts new information into practice. The training will improve referral-making and increase communication and teamwork in the multidisciplinary environments and the ED. Success will be measured in the number of ED nurses who receive training. Nurses will recognize bruises that are highly specific to abuse, along with bruising that less specific and more commonly seen in non-abused children. Nurses will recognize that bruising patterns in abused children differ from those in non-abused children. Bridging the gap in knowledge and communication will increase the number of young children who are provided appropriate evaluation for non-accidental injuries.
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