O3228: Implementation of an Epic-Based Universal Screening Tool for Detecting Non-Accidental Trauma in Pediatric Patients

Background: In 2024, the electronic health record (EHR) system Epic released a universal screening tool to detect non-accidental trauma (NAT) in pediatric patients. Although some children’s hospitals have previously created their own screening tools, the release of this screening tool as part of the nation’s largest EHR allows any institution that utilizes Epic to rapidly implement an NAT screening without the expense of creating their own tool. Our pediatric emergency department was among the first to implement and evaluate this screening tool.

Methods: All patients under four years old seen in our pediatric emergency department were screened by the universal EHR screening tool. The triage nurse received a four-question screening tool which they were trained to complete quickly after seeing the patient. The tool was based off the previously validated Ten-4-FACESp. If at least one of the four questions was answered affirmatively, the screening was considered positive and a Best Practice Advisory (BPA) appeared to the attending emergency physician. The attending physician could order consults to social work and/or the Suspected Child Abuse and Neglect (SCAN) team through this BPA. They could also choose to mark the case as low risk for NAT.

Results: Over a nine month period between May 2024 and February 2025, 8560 patients were eligible for screening. 8031 (93.8%) of the screenings were completed, and 153 screenings (1.9% of completed screenings) were positive. 66 of the 153 (43%) of the positive screens were indicated to have low risk for NAT by the attending emergency physician. Of the 87 positive cases that were not marked as low risk, 80 cases received further consultation from the social work and/or SCAN teams. At least 37 of the 153 positive screenings (24%) resulted in CPS reports.

Conclusion: This study evaluated the feasibility of implementing an “out of the box” EHR-based NAT screening tool. The tool was found to be effective in screening for potential cases of NAT without placing significant burden on local ER resources during implementation. This is promising for future dissemination into community ERs who may not have institutional resources to develop their own custom screening tool, but nevertheless are where the majority of abused children initially present to care.