Preliminary Development of a Performance Assessment Tool for Documentation of History Taking in Child Physical Abuse

Burrell, Tanya; Moffatt, Mary; Toy, Serkan; Nielsen-Parker, Monica; Anderst, James D.

doi:10.1097/pec.0000000000000442

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…[15][16][17][18][19][20][21] This need for greater detail in research studies mirrors the standards of practice in medical forensic evaluations. 2,27,28 Despite the clinical need for data regarding likelihood of abuse based on specifics such as fracture morphology and fall history, little comparative data exist to support clinicians in assigning abuse risk in mobile young children with extremity fractures. As such, expert consensus often serves as a basis for practice guidelines.…”

Section: Resultsmentioning

confidence: 99%

“…Whereas prior studies, at times, relied on circular logic to assign abuse risk, newer data rely on extremely detailed information regarding the mechanics of an injury event, 8 bone strength, 26 and noncircular methods of assigning abuse risk 15–21 . This need for greater detail in research studies mirrors the standards of practice in medical forensic evaluations 2,27,28 . Despite the clinical need for data regarding likelihood of abuse based on specifics such as fracture morphology and fall history, little comparative data exist to support clinicians in assigning abuse risk in mobile young children with extremity fractures.…”

Section: Discussionmentioning

confidence: 99%

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Fractures Presumed to Be Low Risk for Abuse in Young Mobile Children

Murray¹,

Fickenscher²,

Moffatt

et al. 2020

Pediatr Emer Care

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Objectives: To evaluate the likelihood of abuse for various fractures, we aimed to compare the prevalence of concomitant suspicious injuries (CSIs) in subjects with fractures presumed to be low risk for abuse to those with non-low-risk fractures (aim 1) and to evaluate the prevalence of low-risk and non-low-risk fractures identified on skeletal survey (SS) (aim 2).Methods: Subjects included toddlers 9 to 23 months of age presenting to a children's hospital system with a fracture and having an SS completed (aim 1) as well as those who had an SS completed for any concern for abuse (aim 2). For aim 1, we performed a 5-year retrospective case-control study. Low-risk fractures were defined as extremity buckle, clavicle, supracondylar, or toddler's fractures. Controls included moderate-and high-risk fracture groups. Groups were compared for the prevalence of CSIs. For aim 2, we described the frequencies of all fracture types identified by SS completed for any concern for abuse over the same period.Results: For aim 1, there were 58 low-risk, 92 moderate-risk, and 8 high-risk fractures. The rates of CSIs were not significantly different between low-and moderate-risk fractures (odds ratio, 0.9; 95% confidence interval, 0.4-2.5), whereas half of high-risk fractures had CSIs. Forty-five subjects had an occult fracture on SS completed for any abuse concern. All low-risk fractures were identified by SS, most commonly buckle fractures (22.2% of cases). Conclusions:Fractures presumed to be low risk for abuse in young, mobile children require consideration of abuse as a cause.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fractures Presumed to Be Low Risk for Abuse in Young Mobile Children

Murray¹,

Fickenscher²,

Moffatt

et al. 2020

Pediatr Emer Care

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“…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%

“…Whereas prospective studies have identified compelling evidence for population risk indicators for child abuse, it is unknown to what extent CAP consultation notes in cases of suspected child physical abuse reflect these social risk factors. Although recent studies have used consensus processes to define key consultation elements for the medical evaluation of child abuse (Burrell, Moffatt, Toy, Nielsen-Parker, & Anderst, 2016; Campbell, Olson, & Keenan, 2015) there is still debate among CAPs regarding what elements of a child and families’ social ecology to include in the social history (Burrell et al, 2016; Campbell et al, 2015; Mian et al, 2009). The goal of this study was to qualitatively examine and describe the types of risk and protective factors recorded by CAPs as part of their comprehensive evaluation of children injured by physical abuse.…”

Section: Introductionmentioning

confidence: 99%

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

Olson

Campbell

Cook

et al. 2018

Child Abuse & Neglect

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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.

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Simulation-based research to improve infant health outcomes: Using the infant simulator to prevent infant shaking

Bechtel

Bhatnagar

Auerbach

2019

Infant Behavior and Development

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Preliminary Development of a Performance Assessment Tool for Documentation of History Taking in Child Physical Abuse

Abstract: Initial evaluation suggests the PHAAT may be a reliable and valid practice assessment tool for the medical evaluation of physical abuse.

Cited by 4 publications

References 10 publications

Fractures Presumed to Be Low Risk for Abuse in Young Mobile Children

Fractures Presumed to Be Low Risk for Abuse in Young Mobile Children

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

Simulation-based research to improve infant health outcomes: Using the infant simulator to prevent infant shaking

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