Analysis of Missed Cases of Abusive Head Trauma

Jenny, Carole; Hymel, Kent P.; Ritzen, Alene; Reinert, Steven E.; Hay, Thomas C.

doi:10.1001/jama.281.7.621

Cited by 959 publications

(619 citation statements)

References 26 publications

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“…[67][68][69][70] The prevalence of abuse in young children with head injury was also high, ranging from 14% to 70% depending on the age of the child, the type and severity of head injury and the measurement of physical abuse. [71][72][73][74][75][76] …”

Section: Review Resultsmentioning

confidence: 99%

“…Jenny, USA, 1999 (head) 74 Brown, USA, 2003 (head) 72 Ziegler, Australia, 2005 (fracture) 86 Scherl, USA, 2000 (fracture) 83 Oral, USA, 2003 (fracture) 82 Carty, UK, 2002 (fracture) 85 Kumar, UK,1984 (burns) 81 Clark, USA, 1997 (burns) 80 Hoskote depending on the type and severity of injury, the threshold for referral, the criteria for confirmation of abuse and the accuracy of clinicians who decided which children to refer. All of the included studies were based on specific injury groups that would be classified post hoc, after investigation, and which are therefore likely to be based on highly selected populations, at higher risk of abuse than the average injured child attending A&E. 65,70,87 The included studies suggest some consistency in the risk of abuse for burns 80,81 but not for other types of injury.…”

Section: Review Resultsmentioning

confidence: 99%

“…Three studies 72,74,85 examined immediate or delayed referral of children in whom abuse was eventually confirmed (see Table 13). As all three studies overestimated sensitivity because abused children who were never referred were not included in the denominator, they provide an upper limit for sensitivity in the hospital setting (69%, 74 67% 72 and 88% 85 ).…”

Section: Review Resultsmentioning

confidence: 99%

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Performance of screening tests for child physical abuse in accident and emergency departments

Woodman¹,

Pitt²,

Wentz³

et al. 2008

Health Technol Assess

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How to obtain copies of this and other HTA Programme reports. An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable CD-ROM is also available (see below).Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment ProgrammeT he Health Technology Assessment (HTA) Programme, part of the National Institute for HealthResearch (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA Programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA Programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research are actively sought from people working in t...

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Section: Review Resultsmentioning

confidence: 99%

Section: Review Resultsmentioning

confidence: 99%

Section: Review Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Performance of screening tests for child physical abuse in accident and emergency departments

Woodman¹,

Pitt²,

Wentz³

et al. 2008

Health Technol Assess

View full text Add to dashboard Cite

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“…Over the past 25 years, research has repeatedly highlighted missed opportunities to evaluate and diagnose abuse in young, injured children, resulting in children suffering from undiagnosed injuries as well as ongoing abuse. [36][37][38][39][40][41][42][43] Research has also revealed that racial and socioeconomic status (SES)-based biases influence decision-making regarding child abuse evaluations and diagnoses. 17,31,35,44,45 A single institution study of unwitnessed TBI in infants showed that implementation of a guideline for universal occult fracture evaluation in this population can eliminate racial and SES-based disparities and might increase the detection of abuse.…”

Section: Discussionmentioning

confidence: 99%

Evaluation for Occult Fractures in Injured Children

et al. 2015

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OBJECTIVES: To examine variation across US hospitals in evaluation for occult fractures in (1) children ,2 years old diagnosed with physical abuse and (2) infants ,1 year old with injuries associated with a high likelihood of abuse and to identify factors associated with such variation. METHODS:We performed a retrospective study in children ,2 years old with a diagnosis of physical abuse and in infants ,1 year old with non-motor vehicle crash-related traumatic brain injury or femur fractures discharged from 366 hospitals in the Premier database from 2009 to 2013. We examined across-hospital variation and identified child-and hospital-level factors associated with evaluation for occult fractures.RESULTS: Evaluations for occult fractures were performed in 48% of the 2502 children with an abuse diagnosis, in 51% of the 1574 infants with traumatic brain injury, and in 53% of the 859 infants with femur fractures. Hospitals varied substantially with regard to their rates of evaluation for occult fractures in all 3 groups. Occult fracture evaluations were more likely to be performed at teaching hospitals than at nonteaching hospitals (all P , .001). The hospital-level annual volume of young, injured children was associated with the probability of occult fracture evaluation, such that hospitals treating more young, injured patients were more likely to evaluate for occult fractures (all P , .001).CONCLUSIONS: Substantial variation in evaluation for occult fractures among young children with a diagnosis of abuse or injuries associated with a high likelihood of abuse highlights opportunities for quality improvement in this vulnerable population.WHAT'S KNOWN ON THIS SUBJECT: Screening for occult fractures is a key component of the medical evaluation for young victims of suspected physical abuse. Little is known about adherence to occult fracture evaluation guidelines in children with suspected abuse cared for at non-pediatric-focused hospitals.WHAT THIS STUDY ADDS: Occult fracture evaluations were performed in half of young children diagnosed with abuse or injuries concerning for abuse in a large cohort of hospitals. Evaluations were more common at hospitals caring for higher volumes of young, injured children.

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“…It is well documented that the diagnosis of child abuse is missed by unsuspecting physicians and that diagnostic specificity is improved when physicians are adequately trained to recognize both inflicted injuries and medical mimickers of abuse. 19,20 It is concerning that physicians in Alabama, and likely throughout the country, are asked to evaluate and care for patients with such potentially important diagnoses without adequate training, experience, or professional support. Considering that child maltreatment is more prevalent than cancer and just as fatal, it should warrant more attention during residency training than the time spent on recognizing less commonly occurring diseases.…”

Section: Physicians In Practicementioning

confidence: 99%

Professional Education in Child Abuse and Neglect

Christian

2008

Pediatrics

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Physicians have reported feeling that they were not adequately trained to identify and report child abuse. This article reviews the current state of medical education and residency training and the needs of physicians in practice and proposes changes and additions that can be made to improve the ability and confidence of physicians who are faced with the responsibility of keeping children safe. Pediatrics 2008;122:S13-S17 A MONG OUR MANY responsibilities, physicians are sentinels for child maltreatment. Federal and state laws mandate us to report suspected cases of abuse and neglect for investigation, and our ethical mandate is to use our skills to promote the health, safety, and well-being of our patients. Yet, despite our best intentions, the data suggest that many physicians are unable to fulfill the mandate to protect children from abuse and neglect. 1,2 Physician inability to identify abused children and resistance to reporting suspected abuse is explained by many considerations, as noted in the Child Abuse Recognition Experience Study (CARES). 1,2 One of the more important contributors to physicians' discomfort with the management of child and family violence is their lack of education and training about the problem. In all specialties in medicine, clinical competence is based in both knowledge and experience. If the aim of medical education is to improve practice, rather than simply knowledge, appropriate education must ensure that physicians are capable of identifying child abuse, addressing the concern with families, reporting suspicions to the proper authorities, assisting investigators with interpretation of medical information, managing medical consequences of both physical and psychological trauma, advocating for their patients, and working with families affected by child maltreatment. It is a lot to learn, and the evidence published to date suggests that we have not done our job sufficiently. 1,2 MEDICAL STUDENT EDUCATION Accreditation of US medical schools is obtained through the Liaison Committee on Medical Education (LCME). Accreditation by the LCME is required for medical schools to receive federal grants for education, and the majority of state licensing boards require US medical schools to be accredited by the LCME. The LCME publishes accreditation standards that address the structure of medical education for all students. Clinical education is required for all organ systems and must include ambulatory experience. In the most recent revision of the accreditation standards, the LCME states, "The curriculum must prepare students for their role in addressing the medical consequences of common societal problems, for example, providing instruction in the diagnosis, prevention, appropriate reporting, and treatment of violence and abuse." 3 Although the standards for medical education explicitly include a requirement for education in social issues such as child abuse, the responsibility for curriculum development rests with medical school faculty and is not specifically dictated by accrediti...

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Analysis of Missed Cases of Abusive Head Trauma

Abstract: Although diagnosing head trauma can be difficult in the absence of a history, it is important to consider inflicted head trauma in infants and young children presenting with nonspecific clinical signs.

Cited by 959 publications

References 26 publications

Performance of screening tests for child physical abuse in accident and emergency departments

Performance of screening tests for child physical abuse in accident and emergency departments

Evaluation for Occult Fractures in Injured Children

Professional Education in Child Abuse and Neglect

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