{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:43:38Z","timestamp":1792115018873,"version":"4.4.0"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["5K12HS026393\u201003"],"award-info":[{"award-number":["5K12HS026393\u201003"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To determine the prevalence of abuse\u2010related red flags and the frequency of subsequent evaluations among young children presenting to the emergency department (ED) with trauma\u2010related complaints, and to quantify the association between red flags and further evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of children &lt;\u20093\u2009years presenting to a tertiary paediatric ED in 2019 with trauma\u2010related chief complaints identified from structured electronic health record (EHR) data. Red flags were categorised as historical, physical, diagnostic, or caretaker\/household. Two trained abstractors independently coded red flags from explicit provider documentation; discrepancies were resolved by consensus (inter\u2010rater reliability on a 20% sample; kappa\u2009=\u20090.82). Outcomes were the performance of skeletal surveys, laboratory testing, and social work\/child protection consultations. Logistic regression estimated the association between red flags and any subsequent evaluation, adjusting for age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 962 eligible trauma\u2010related visits, 317 children (33%) had \u2265\u20091 documented red flag. Across the cohort, 8.6% received a skeletal survey, 4.3% had laboratory testing, and 1.5% had a social work consultation. Children with any red flag were more likely to undergo further evaluation (adjusted OR [aOR] 3.7; 95% CI: 2.5\u20135.4). Historical red flags were associated with skeletal survey (OR 3.7, 95% CI: 1.3\u201311) and laboratory tests (OR 4.1, 95% CI: 1.3\u201313.6). Physical red flags were associated with skeletal survey (OR 6.4, 95% CI: 2.1\u201319.6) and laboratories (OR 5.3, 95% CI: 1.5\u201319). Diagnostic red flags were associated with skeletal survey (OR 7.0, 95% CI: 2.3\u201321.6) and neuroimaging (OR 2.4, 95% CI: 1.3\u20134.5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion(s)<\/jats:title>\n                    <jats:p>One in three children under age 3 with trauma\u2010related ED visits had documented red flags suggestive of possible abuse, yet comprehensive evaluations were infrequent. Findings support the need for nuanced, standardised approaches that prioritise high\u2010yield flags while avoiding extensive evaluations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jpc.70230","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T12:25:42Z","timestamp":1762777542000},"page":"42-50","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Missed Recognition of Potential Abuse in Young Children Presenting to the Emergency Department: A Retrospective Study"],"prefix":"10.1111","volume":"62","author":[{"given":"Linda","family":"Ren","sequence":"first","affiliation":[{"name":"Nemours Children's Health Department of Pediatrics University of Central Florida College of Medicine  Orlando Florida USA"},{"name":"Baylor College of Medicine, Department of Anesthesia, One Baylor Plaza  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Baughn","sequence":"additional","affiliation":[{"name":"Nemours Children's Health Department of Pediatrics University of Central Florida College of Medicine  Orlando Florida USA"},{"name":"Department of Surgery University of Texas Medical Branch 301 University Blvd  Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ali\u2010Panzarella","sequence":"additional","affiliation":[{"name":"Nemours Children's Health Department of Pediatrics University of Central Florida College of Medicine  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Rivera\u2010Sepulveda","sequence":"additional","affiliation":[{"name":"Nemours Children's Health Department of Pediatrics University of Central Florida College of Medicine  Orlando Florida USA"},{"name":"Nemours Children's Health, Department of Pediatrics, Division of Emergency Medicine and Urgent Care  Orlando Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"e_1_2_10_2_1","article-title":"Administration for Children and Families, Administration on Children, Youth\u00a0and\u00a0Families, Children\u2019s Bureau","author":"U.S. Department of Health and Human Services","year":"2025","journal-title":"Child Maltreatment 2023"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2019.02.012"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nurpra.2024.104935"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40621-024-00495-4"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocz069"},{"key":"e_1_2_10_7_1","volume-title":"New Directions in Child Abuse and Neglect Research","author":"Petersen A.","year":"2014"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/cdep.12317"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13052-022-01214-9"},{"issue":"2","key":"e_1_2_10_10_1","first-page":"72","article-title":"Child Maltreatment, Abuse, and Neglect: An Umbrella Review of Their Prevalence and Definitions","volume":"20","author":"Massullo C.","year":"2023","journal-title":"Clinical Neuropsychiatry"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2018.07.081"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2024.04.025"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2015-0356"},{"issue":"4","key":"e_1_2_10_14_1","article-title":"Identifying the Challenges of Child Abuse Detection Among Emergency, Pediatrics, and Family Medicine Practitioners in Saudi Arabia","volume":"15","author":"AlShalhoub N. M.","year":"2023","journal-title":"Cureus"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.5832"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000003029"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-3977"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.51546"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1195440"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2021.05.006"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2019.0097"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2019.19010020"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2016.01.019"}],"container-title":["Journal of Paediatrics and Child Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jpc.70230","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jpc.70230","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jpc.70230","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T08:28:23Z","timestamp":1768379303000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jpc.70230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,10]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/jpc.70230"],"URL":"https:\/\/doi.org\/10.1111\/jpc.70230","archive":["Portico"],"relation":{},"ISSN":["1034-4810","1440-1754"],"issn-type":[{"value":"1034-4810","type":"print"},{"value":"1440-1754","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,10]]},"assertion":[{"value":"2025-08-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}