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. 2019 Jun 14;26(10):1020–1029. doi: 10.1093/jamia/ocz069

Table 1.

Triggers embedded into the EHR at UPMC Hamot and UPMC Mercy

Form name/who completes the form Name and value of field which results in a trigger when combined with patient age Age requirement for triggering Criteria which prevents activation of the child abuse alert system First trigger
Child abuse screening form/RN “Are any of the following findings present on physical examination? In a non-mobile child – ANY bruise, burn, subconjunctival hemorrhage, or frenulum injury. In a mobile child – Bruises, burns or other markings in the shape of an object; or Bruises on non-bony prominences/protected regions (eg, torso, genitalia/buttocks, upper arms, ear, neck); or More bruises than you would expect to see in even an active child.” with “yes” response (Q3) <2 y NA 16 (10)
Child abuse screening form/RN “Are you concerned that the history may not be consistent with the injury or illness” with a “yes” response (Q2) <2 y NA 13 (8)
ED Assessment Form v2: Focused assessment of complaint; Chief complaint/RN Any of the following words in a CC or focused assessment for a child <12 months of age: assault, abuse, bruis, burn, not moving, fracture, fx, broke, injury, sprain, deformity, subconjunctival hemorrhage, petechiae, arrest, hematom, ecc, echy, OR contus <1 y (<6 mo for “injury”) Do not trigger if trigger word is preceded by denie, no, or not; if Burn is preceded by Dr; if cord precedes fall or fell; if broke is followed by out, English, or or; if fever precedes broke 54 (35)
ED Assessment Form v2: Chief complaint; focused assessment/RN Any of the following words in a child <6 months of age: “fall,” “fell” <6 mo Do not trigger if Fall or Fell is followed by asleep do not trigger on fallot 28 (18)
Orders/MD Order for bone survey infant x-ray, bone survey limited x-ray or bone survey x-ray <2 y NA 14 (9)
Orders/MD Order for x-ray of clavicle, foot, finger, hand, knee, femur, tibia, fibula, wrist, ankle, skull, elbow, humerus, shoulder, skeletal, or extremity <1 y NA 7 (4)
Discharge/MD DC instruction title of abuse, fracture, injury, injuries, burn, cast, contusion, clavicle, dislocation, subluxation, hematoma, hyphema, nursemaid, hemorrhage, or bruise <1 y Do not trigger is if inj is preceded by head 13 (8)
Discharge/MD DC diagnosis of “contus” <1 y 8 (5)
Discharge/MD DC instruction of child abuse, abuse and neglect, jaw fracture, nose fracture, sternum fracture, or rib fracture <2 y NA 1 (1)
Discharge/MD Follow up in depart with clinic or office that has ortho, plastic, burn trauma (to pick up Burn Trauma Center-UPMC Mercy; Children's Hospital Orthopedic Clinic; CHP Orthopedics; CHP Plastics Department; Hamot Orthopedic Clinic; Hamot Orthopedic Hand; Hamot Orthopedics) <1 y NA 2 (1)

Values are n (%).

CA-CDSS: child abuse clinical decision support system; CHP: Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center; DC: discharge; ED: emergency department; EHR: electronic health record; MD: medical doctor; NA: not applicable; RN: registered nurse; UPMC: University of Pittsburgh Medical Center.