Abstract
Objective
Guidelines and pathways exist to help frontline providers evaluate injured children
for suspected child abuse. Little, however, is known about whether the decision-making
resulting from these interventions is correct. Therefore, in the absence of an available
gold-standard test, we used experts’ judgments to examine the appropriateness of these
clinical decisions. We evaluated community emergency department (ED) providers’ adherence
to a guideline recommending a child protection team (CPT) consultation for infants
with injuries associated with abuse. We then compared providers’ decision-making to
experts’ recommendations before and after guideline implementation.
Methods
Two experts conducted a blinded, retrospective review of injured infants from 3 community
EDs (N = 175). Experts rated the likelihood that an injury was abusive, indeterminate,
or accidental, and made recommendations that were compared with skeletal survey (SS)
testing and child protective services (CPS) reporting by providers before and after
guideline implementation.
Results
Postguideline implementation, there was a significant increase in CPT consultations
in indeterminate cases (14.3% vs 72.2%, P < .001) and in SS testing when experts recommended SS (20.6% vs 56.8%, P = .002). In contrast, a higher percentage of cases for whom the experts did not recommend
reporting were reported to CPS (1.8% vs 14.6%, P = .02).
Conclusions
Providers consulted the CPT most often for indeterminate cases. SS testing was in
line with expert recommendations, but CPS reporting diverged from expert recommendations.
Interventions linking community ED providers with a CPT may improve the evaluation
of infants with injuries concerning for abuse.
Keywords
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Article Info
Publication History
Published online: November 04, 2020
Accepted:
November 1,
2020
Received:
July 1,
2020
Footnotes
Conflicts of Interest: Andrea Asnes reports that the Department of Pediatrics receives payment for her expert testimony in child abuse cases and that she receives grants from the State of Connecticut to support the Yale Child Abuse Programs. John Leventhal reports that the Department of Pediatrics receives payment for his expert testimony in child abuse cases.
Identification
Copyright
Copyright © 2020 by Academic Pediatric Association
