Sage Journals: Discover world-class research

Abstract

The aim of this study was to examine the frequency with which child abuse pediatricians (CAPs) assess consultations as low versus high likelihood of abuse. In this retrospective secondary analysis of data from the Examining Siblings to Recognize Abuse (ExSTRA) study, the likelihood of abuse score for 2890 consultations at 20 medical centers was collected. Descriptive statistics were used to examine the percentage of cases representing low versus high likelihood of abuse (i.e., score of 1–4 vs. 5–7 on a 7-point scale). Linear and logistic regression analyses were used to examine score variability between medical centers. Overall, fifty-three percent of cases were assessed as low likelihood of abuse, suggesting that CAPs were equally as likely to assess a high versus low likelihood of abuse. The percentage of cases representing low likelihood of abuse differed significantly (P < .001) between medical centers after controlling for patient age, sex, race/ethnicity, twin/triplet status, injury types, and injury severity. The variability between CAP assessments at different medical centers is discussed, along with potential contributors to this variability and directions for future work.

Keywords

child abuse physical abuse assessment decision making systems

Get full access to this article

View all access options for this article.

References

Adams

J. A.

Starling

S. P.

Frasier

L. D.

Palusci

V. J.

Shapiro

R. A.

Finkel

M. A.

Botash

A. S.

(2012). Diagnostic accuracy in child sexual abuse medical evaluation: role of experience, training, and expert case review. Child Abuse and Neglect, 36(5), 383-392. DOI: 10.1016/j.chiabu.2012.01.004.

Anderst

Kellogg

Jung

(2009). Is the diagnosis of physical abuse changed when child protective services consults a child abuse pediatrics subspecialty group as a second opinion? Child Abuse and Neglect, 33(8), 481-489. DOI: 10.1016/j.chiabu.2009.05.001.

Asnes

A. G.

Pavlovic

Moller

Schaeffer

Leventhal

J. M.

(2021). Consultation for child physical abuse: beyond the history and physical examination. Child Abuse and Neglect, 111, 104792. DOI: 10.1016/j.chiabu.2020.104792.

Buesser

K. E.

Leventhal

J. M.

Gaither

J. R.

Tate

Cooperman

D. R.

Moles

R. L.

Silva

C. T.

Ehrlich

L. J.

Sharkey

M. S.

(2017). Inter-rater reliability of physical abuse determinations in young children with fractures. Child Abuse and Neglect, 72, 140-146. DOI: 10.1016/j.chiabu.2017.08.001.

Chaiyachati

B. H.

Asnes

A. G.

Moles

R. L.

Schaeffer

Leventhal

J. M.

(2016). Gray cases of child abuse: investigating factors associated with uncertainty. Child Abuse and Neglect, 51, 87-92. DOI: 10.1016/j.chiabu.2015.11.001.

Christian

C. W.

(2015). The evaluation of suspected child physical abuse. Pediatrics, 135(5), e1337-e1354. DOI: 10.1542/peds.2015-0356.

Clifford

(2020). When the misdiagnosis is child abuse. The Atlantic. https://www.theatlantic.com/family/archive/2020/08/when-misdiagnosis-child-abuse/615337/.

Crumm

C. E.

Brown

E. C. B.

Thomas-Smith

D. T. Y.

Metz

J. B.

Feldman

K. W.

(2021). Evaluation of an emergency department high-risk bruising screening protocol. Pediatrics, 147(4), e2020002444. DOI: 10.1542/peds.2020-002444.

Dorfman

M. V.

Metz

J. B.

Feldman

K. W.

Farris

Lindberg

D. M.

(2018). Oral injuries and occult harm in children evaluated for abuse. Archives of Disease in Childhood, 103(8), 747-752. DOI: 10.1136/archdischild-2017-313400.

10.

Gabaeff

S. C.

(2016). Exploring the controversy in child abuse pediatrics and false accusations of abuse. Leg Med (Tokyo), 18, 90-97. DOI: 10.1016/j.legalmed.2015.12.004.

11.

Giardino

A. P.

Hanson

Hill

K. S.

Leventhal

J. M.

(2011). Child abuse pediatrics: new specialty, renewed mission. Pediatrics, 128(1), 156-159. DOI: 10.1542/peds.2011-0363.

12.

Greiner

M. V.

Berger

R. P.

Thackeray

J. D.

Lindberg

D. M.

(2013). Dedicated retinal examination in children evaluated for physical abuse without radiographically identified traumatic brain injury. The Journal of Pediatrics, 163(2), 527-531. DOI: 10.1016/j.jpeds.2013.01.063.

13.

Hendrix

A. D.

Conway

L. K.

Baxter

M. A.

(2020). Legal outcomes of suspected maltreatment cases evaluated by a child abuse pediatrician as part of a multidisciplinary team investigation. Journal of Forensic Sciences, 65(5), 1517-1523. DOI: 10.1111/1556-4029.14463.

14.

Hicks

R. A.

Laskey

A. L.

Harris

T. L.

Hibbard

R. A.

(2020). Consultations in child abuse pediatrics. Clinical Pediatrics, 59(8), 809-881. DOI: 10.1177/0009922820920019.

15.

Hixenbaugh

M. a. B., K.

(2019). A Devastating Diagnosis. Houston, Texas: Houston Chronicle. https://www.houstonchronicle.com/news/investigations/article/A-Devastating-Diagnosis-14419072.php.

16.

Holick

M. F.

Hossein-Nezhad

Tabatabaei

(2017). Multiple fractures in infants who have Ehlers-Danlos/hypermobility syndrome and or vitamin D deficiency: a case series of 72 infants whose parents were accused of child abuse and neglect. Dermatoendocrinol, 9(1), e1279768. DOI: 10.1080/19381980.2017.1279768.

17.

Hooft

A. M.

Asnes

A. G.

Livingston

Deutsch

Cahill

Wood

J. N.

Leventhal

J. M.

(2015). The accuracy of ICD codes: identifying physical abuse in 4 children’s hospitals. Academic Pediatrics, 15(4), 444-450. DOI: 10.1016/j.acap.2015.01.008.

18.

Hymel

K. P.

Laskey

A. L.

Crowell

K. R.

Wang

Armijo-Garcia

Frazier

T. N.

Tieves

K. S.

Foster

Weeks

Pediatric Brain Injury Research Network, I (2018). Racial and ethnic disparities and bias in the evaluation and reporting of abusive head trauma. The Journal of Pediatrics, 198, 137-143. DOI: 10.1016/j.jpeds.2018.01.048.

19.

Laskey

A. L.

Sheridan

M. J.

Hymel

K. P.

(2007). Physicians’ initial forensic impressions of hypothetical cases of pediatric traumatic brain injury. Child Abuse and Neglect, 31(4), 329-342. DOI: 10.1016/j.chiabu.2006.02.017.

20.

Lindberg

D. M.

Lindsell

C. J.

Shapiro

R. A.

(2008). Variability in expert assessments of child physical abuse likelihood. Pediatrics, 121(4), e945-e953. DOI: 10.1542/peds.2007-2485.

21.

Lindberg

D. M.

Shapiro

R. A.

Laskey

A. L.

Pallin

D. J.

Blood

E. A.

Berger

R. P.

(2012). Prevalence of abusive injuries in siblings and household contacts of physically abused children. Pediatrics, 130(2), 193-201. DOI: 10.1542/peds.2012-0085.

22.

Lorenz

D. J.

Pierce

M. C.

Kaczor

Berger

R. P.

Bertocci

Herman

B. E.

Herr

Hymel

K. P.

Jenny

Leventhal

J. M.

Sheehan

Zuckerbraun

(2018). Classifying injuries in young children as abusive or accidental: reliability and accuracy of an expert panel approach. The Journal of Pediatrics, 198, 144-150. DOI: 10.1016/j.jpeds.2018.01.033.

23.

Lynoe

Elinder

Hallberg

Rosen

Sundgren

Eriksson

(2017). Insufficient evidence for ‘shaken baby syndrome’—a systematic review. Acta Paediatrica, 106(7), 1021-1027. DOI: 10.1111/apa.13760.

24.

Martindale

Swenson

Coffman

Newton

A. W.

Lindberg

D. M.

(2014). Recurrent concerns for child abuse: repeated consultations by a subspecialty child abuse team. Child Abuse and Neglect, 38(7), 1259-1266. DOI: 10.1016/j.chiabu.2014.03.007.

25.

McGuire

Martin

K. D.

Leventhal

J. M.

(2011). Child abuse consultations initiated by child protective services: the role of expert opinions. Academic Pediatrics, 11(6), 467-473. DOI: 10.1016/j.acap.2011.06.005.

26.

Metz

J. B.

Schwartz

K. A.

Feldman

K. W.

Lindberg

D. M.

(2014). Non-cutaneous conditions clinicians might mistake for abuse. Archives of Disease in Childhood, 99(9), 817-823. DOI: 10.1136/archdischild-2013-304701.

27.

Miller

Stolfi

Ayoub

(2019). Findings of metabolic bone disease in infants with unexplained fractures in contested child abuse investigations: a case series of 75 infants. Journal of Pediatric Endocrinology & Metabolism: JPEM, 32(10), 1103-1120. DOI: 10.1515/jpem-2019-0093.

28.

Moles

R. L.

Asnes

A. G.

(2014). Has this child been abused? Exploring uncertainty in the diagnosis of maltreatment. Pediatric Clinics of North America, 61(5), 1023-1036. DOI: 10.1016/j.pcl.2014.06.009.

29.

Pawlik

M. C.

Kemp

Maguire

Nuttall

Feldman

K. W.

Lindberg

D. M.

(2016). Children with burns referred for child abuse evaluation: Burn characteristics and co-existent injuries. Child Abuse and Neglect, 55, 52-61. DOI: 10.1016/j.chiabu.2016.03.006.

30.

Pierce

M. C.

Kaczor

Lorenz

D. J.

Bertocci

Fingarson

A. K.

Makoroff

Berger

R. P.

Bennett

Magana

Staley

Ramaiah

Fortin

Currie

Herman

B. E.

Herr

Hymel

K. P.

Jenny

Sheehan

Zuckerbraun

Leventhal

J. M.

(2021). Validation of a clinical decision rule to predict abuse in young children based on bruising characteristics. JAMA Netw Open, 4(4), e215832. DOI: 10.1001/jamanetworkopen.2021.5832.

31.

Shahi

A. K.

Phillips

Shirek

Lindberg

D. M.

Moulton

S. L.

(2021). Using deep learning and natural language processing models to detect child physical abuse. Journal of Pediatric Surgery. (in press). DOI: 10.1016/j.jpedsurg.2021.03.007.

32.

Statement of the Innocence Network on Shaken Baby Syndrome/Abusive Head Trauma (2019). https://innocencenetwork.org/wp-content/uploads/STATEMENT-OF-THE-INNOCENCE-NETWORK-ON-SHAKEN-BABY-SYNDROME-6.14.19-1.pdf.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.07 MB

Child Abuse Pediatricians Assess a Low Likelihood of Abuse in Half of 2890 Physical Abuse Consults

Abstract

Keywords

Get full access to this article

References

Supplementary Material