Melissa K Egge

All Publications

• Implementation of Universal Child Abuse Screening Tool (U-CAST): Real-world implementation of a standardized electronic health record-based child physical abuse screening in the pediatric emergency department. Child abuse & neglect Knowlton, M., Cauley, E., Hammond, B., Lee, M., Egge, M. K., Harnish, E., Chao, S. D. 2026; 179: 108234

  Abstract

  Universal screening tools can help detect child physical abuse. Epic released an electronic health record-embedded universal child physical abuse screening tool (U-CAST) that can quickly be implemented by any institution that uses Epic.We evaluated the first year of implementation of an adapted U-CAST in the pediatric emergency department at an academic hospital.All patients less than four years of age who arrived in the pediatric emergency department were screened using a four-question tool embedded into the electronic health record.A screen was positive if at least one question was answered "yes". For positive screens, a Best Practice Advisory prompted the attending to document low risk, order specialty consultation, or indicate they were not the responsible physician. The Suspected Child Abuse and Neglect (SCAN) team reviewed all positive screens.From May 28, 2024 to May 27, 2025, 11,326 screenings were initiated; 10,634 (93.9%) were completed and 198 (1.7%) were positive. Thirty-eight positive screens were associated with Child Protective Services (CPS) reports for concern of child physical abuse (true positives). Eight CPS reports for concern of child physical abuse occurred after negative or incomplete screens. Demographic proportions were similar across screening stages. Implementation achieved a 97% corrected completion rate and an 83% sensitivity for CPS reports for concern for child physical abuse.The successful implementation in the first year is promising evidence for the adoption of U-CAST among pediatric emergency departments. We will continue to monitor sustainability beyond the first year.

  View details for DOI 10.1016/j.chiabu.2026.108234

  View details for PubMedID 42508256

• SCAN for Abuse: Electronic Health Record-Based Universal Child Abuse Screening. Journal of pediatric surgery Martin, N. R., Claypool, A. L., Diyaolu, M., Chan, K. S., A'Neals, E., Iyer, K., Stewart, C. C., Egge, M., Bernacki, K., Hallinan, M., Zuo, L., Gupta, U., Naru, N., Scheinker, D., Morris, A. M., Brandeau, M. L., Chao, S. 2023

  Abstract

  Identification of physical abuse at the point of care without a systematic approach remains inherently subjective and prone to judgement error. This study examines the implementation of an electronic health record (EHR)-based universal child injury screen (CIS) to improve detection rates of child abuse.CIS was implemented in the EHR admission documentation for all patients age 5 or younger at a single medical center, with the following questions. 1) "Is this patient an injured/trauma patient?" 2) "If this is a trauma/injured patient, where did the injury occur?" A "Yes" response to Question 1 would alert a team of child abuse pediatricians and social workers to determine if a patient required formal child abuse clinical evaluation. Patients who received positive CIS responses, formal child abuse work-up, and/or reports to Child Protective Services (CPS) were reviewed for analysis. CPS rates from historical controls (2017-2018) were compared to post-implementation rates (2019-2021).Between 2019 and 2021, 14,150 patients were screened with CIS. 286 (2.0 %) patients screened received positive CIS responses. 166 (58.0 %) of these patients with positive CIS responses would not have otherwise been identified for child abuse evaluation by their treating teams. 18 (10.8 %) of the patients identified by the CIS and not by the treating team were later reported to CPS. Facility CPS reporting rates for physical abuse were 1.2 per 1000 admitted children age 5 or younger (pre-intervention) versus 4.2 per 1000 (post-intervention).Introduction of CIS led to increased detection suspected child abuse among children age 5 or younger.Level II.Study of Diagnostic Test.

  View details for DOI 10.1016/j.jpedsurg.2023.10.025

  View details for PubMedID 37953157

• Medical Child Abuse: A Review by Subspecialty. Advances in pediatrics Egge, M. K. 2023; 70 (1): 59-80

  Abstract

  Medical child abuse (MCA), formerly called Munchausen syndrome by proxy (MSP or MSBP), occurs when a caregiver, usually the mother, falsifies or exaggerates symptoms resulting in harm to a child through inappropriate medical care. MCA is underrecognized, underreported, and results in significant morbidity and mortality. Pediatrics subspecialists should consider MCA when unusual disease presentation [THAT] do not respond to traditional treatments. This article reviews the more common diagnoses encountered in MCA cases by specialty.

  View details for DOI 10.1016/j.yapd.2023.03.005

  View details for PubMedID 37422298