Testing for Abuse in Children With Sentinel Injuries

Abstract

OBJECTIVE: Child physical abuse is commonly missed, putting abused children at risk for repeated injury and death. Several so-called sentinel injuries have been suggested to be associated with high rates of abuse, and to imply the need for routine testing for other, occult traumatic injuries. Our objective was to determine rates of abuse evaluation and diagnosis among children evaluated at leading children's hospitals with these putative sentinel injuries.METHODS: This is a retrospective secondary analysis of the Pediatric Health Information System database. We identified 30 355 children with putative sentinel injuries. We measured rates of abuse diagnosis and rates of testing commonly used to identify occult injuries.RESULTS: Among all visits for children ,24 months old to Pediatric Health Information System hospitals, the rate of abuse diagnosis was 0.17%. Rates of abuse diagnosis for children with at least 1 putative sentinel injury ranged from 3.5% for children ,12 months old with burns to 56.1% for children ,24 months with rib fractures. Rates of skeletal survey and other testing that can identify occult traumatic injury were highly variable between centers and for different injuries.CONCLUSIONS: Several putative sentinel injuries are associated with high rates of physical abuse. Among eligible children with rib fracture(s), abdominal trauma, or intracranial hemorrhage, rates of abuse were more than 20%. Future work is warranted to test whether routine testing for abuse in these children can improve early recognition of abuse.

Research priorities for a multi-center child abuse pediatrics network − CAPNET

“…These findings suggest that implicit biases of medical providers may contribute to disproportionately high rates of child abuse evaluation and reporting for poor or African-American families, and disproportionately high rates of missed abuse in affluent, or White families. (Jenny, Hymel, Ritzen, Reinert, & Hay, 1999; Lindberg et al, 2015; Wood et al, 2012a; Wood, French, Song, & Feudtner, 2015; Wood et al, 2010)…”

“…(Block & Palusci, 2006) The new sub-specialty has also increased the funneling of cases of suspected maltreatment into referral centers, and has raised the possibility of establishing a more uniform standard of care to decrease the broad variability in medical care of maltreated children. (Lindberg, Beaty, Juarez-Colunga, Wood, & Runyan, 2015; Paine, Scribano, Localio, & Wood, 2016; Wood, Fakeye, et al, 2015; Wood et al, 2012a)…”

“…(Bradford, Choudhary, & Dias, 2013; Christian & Block, 2009; Postema, Sieswerda-Hoogendoorn, Majoie, & van Rijn, 2014; Sieswerda-Hoogendoorn, Postema, Verbaan, Majoie, & van Rijn, 2014) Further, variable practice patterns and systems of care for medical, social and law-enforcement professionals limit the generalizability of single center results. (Hooft et al, 2015; Lindberg et al, 2015; Lindberg, Lindsell, & Shapiro, 2008; Wood et al, 2012b; Wood, 2015; Wood, 2014)…”

Variability in Child Protection Medical Evaluations of Suspected Physical Abuse in Four European Countries: A Vignette Study

“…In another study of child protection specialist paediatricians, broad variability was found in the perceived likelihood of physical abuse (Lindberg et al ., ). Several clinical studies from the USA reported considerable variation in the diagnostic investigations used (including skeletal surveys, neuroimaging and blood investigations) and in the identification of child abuse, even after adjusting for individual patient characteristics (Harper et al ., ; Lindberg et al ., ; Wood et al ., ). Other studies examined physicians' attitudes and willingness to report child abuse and neglect (CAN).…”

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

“…Although cross-sectional and retrospective studies provide correlation or association with child abuse and neglect, they do not provide evidence on the cause and effect of abuse or other variables that may mediate the cause and effect. Risk factors associated with abuse include a caretaker’s history of child abuse, negative caretaker perceptions of their child, caretaker affect or behavioral problems including substance abuse, caretaker cognitive and affective deficits, housing instability, non-biological caregiver in the home, chaotic or volatile family situations (Douglas & Mohn, 2014; Duffy, Hughes, Asnes, & Leventhal, 2015; Lindberg, Beaty, Juarez-Colunga, Wood, & Runyan, 2015; Miyamoto et al, 2017; Wathen & MacMillan, 2013; Young et al, 2018). Protective factors that increase family strengths and reduce the likelihood of child abuse and neglect include supportive social networks, stable family relationships, nurturing parenting skills, parental employment and adequate housing (Kumpfer & Magalhães, 2018; Saul et al, 2014; Schofield, Lee, & Merrick, 2013; Stith et al, 2009; Swenson & Chaffin, 2006).…”