Classifying Injuries in Young Children as Abusive or Accidental: Reliability and Accuracy of an Expert Panel Approach

Lorenz, D.; Pierce, Mary Clyde; Kaczor, Kim; Berger, Rachel P.; Bertocci, Gina; Herman, Bruce; Herr, S.; Hymel, Kent P.; Jenny, Carole; Leventhal, John M.; Sheehan, Karen; Zuckerbraun, Noel S.

doi:10.1016/j.jpeds.2018.01.033

Cited by 14 publications

(15 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It deserves mention that differences in biases, beliefs, evidence-based knowledge, and systems-based pressures may contribute to the variability between centers in assessing a high likelihood of abuse. While prior literature has shown that expert panels can have high inter-observer reliability in assessment of child abuse cases (Lorenz et al, 2018), it is also known that implicit biases can affect medico-legal decision-making (Hymel et al, 2018). As we continue to search for the drivers behind the variability in CAP assessments between medical centers, it is important for CAPs to remain transparent and open to the variety of factors that may impact clinical decision-making.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…However, to determine whether this was accidental trauma or not, the expert panel approach was used to determine the nature of the injury. The standardized questions answered were adopted from Lorenz (13). Targeting specific type of injury approach further helped to arrive at a conclusion.…”

Section: Discussionmentioning

confidence: 99%

Multiple Foreign Bodies in a 5-Year Old: Non-Accidental Trauma

Mulenga¹,

Shinondo²,

Bvulani³

2020

Ann Afr Surg.

View full text Add to dashboard Cite

Foreign bodies, a significant proportion of which are a result of non-accidental trauma, are common but under-reported. Pediatric foreign body injuries can be inconsequential, severe or even fatal, and cause long-lasting morbidity and the need for treatment and hospitalization. Evaluation of injury or death requires elements of detection, pattern recognition, interpretation and comparison, all based on clinical, radiological and forensic experience with normal and abnormal findings. We report an unusual and strange case of non-accidental trauma in a young child who presented to our surgical services with 44 sewing needles and wires in his body. The patient had specific characteristics or risks for abuse. His injuries were evaluated, recognized, documented and reported. He was treated for peritonitis and malnutrition and the foreign bodies removed using staged operations under image guidance. Patient’s recovery was uneventful. Keywords: Multiple foreign bodies, Trauma

show abstract

“…Defining needed elements and standardized documentation in the medical evaluation may provide a framework for the development of evaluation tools to make consultation notes more uniform and less subjective. Recent studies have examined different models of child abuse consultations (Keenan & Campbell, 2015), consensus processes to define key consultation elements for the medical evaluation of child abuse (Burrell et al, 2016; Campbell et al, 2015) and the use of structured information in combination with a peer review process (Lorenz et al, 2018). Recent findings suggest that structured information in cases of suspected child abuse without the social history promotes high agreement in diagnosis (Lorenz et al, 2018) while the addition or modification of social history to a CAP consultation note is capable of changing diagnosis in cases with medical uncertainty (Keenan, Cook, Olson, Bardsley, & Campbell, 2017).…”

Section: Discussionmentioning

confidence: 99%

Social history: A qualitative analysis of child abuse pediatricians’ consultation notes

Olson

Campbell

Cook

et al. 2018

Child Abuse & Neglect

View full text Add to dashboard Cite

Background: Child abuse pediatricians (CAPs) are often consulted for injuries when child physical abuse is suspected or when the etiology of a serious injury is unclear. CAPs carefully evaluate the reported mechanism of the child’s injury and the medical findings in the context of the child’s family and social setting to identify possible risk and protective factors for child abuse and the need for social services. It is unknown what population risk indicators along with other social cues CAPs record in the social history of the consultation notes when assessing families who are being evaluated for child physical abuse. Participants and setting: Thirty-two CAPs representing 28 US child abuse programs. Methods: Participants submitted 730 completed cases of inpatient medical consultation notes for three injury types: traumatic brain injury, long bone fracture, and skull fracture in hospitalized children 4 years of age and younger. We defined a priori 12 social cues using known population risk indicators (e.g., single mother) and identified de novo 13 negative (e.g., legal engagement) and ten positive social cues (e.g., competent parenting). Using content analysis, we systematically coded the social history for the social cues. Results: We coded 3,543 cues resulting in a median of 7 coded cues per case. One quarter of the cues were population indicators while half of the cues were negative and one quarter positive. Conclusions: CAPs choose a wide variety of information, not always related to known population risk indicators, to include in their social histories.

show abstract

Classifying Injuries in Young Children as Abusive or Accidental: Reliability and Accuracy of an Expert Panel Approach

Abstract: A panel of experts with different backgrounds but common expertise in pediatric injury is a reliable and accurate criterion standard for classifying pediatric injuries as abusive or accidental in a sample of children presenting to a pediatric emergency department.

Cited by 14 publications

References 27 publications

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

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

Multiple Foreign Bodies in a 5-Year Old: Non-Accidental Trauma

Social history: A qualitative analysis of child abuse pediatricians’ consultation notes

Contact Info

Product

Resources

About