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

BACKGROUND: 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. OBJECTIVE: We evaluated the first year of implementation of an adapted U-CAST in the pediatric emergency department at an academic hospital. PARTICIPANTS AND SETTING: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.