Abstract
Objective
Examine the epidemiology of subspecialty physical abuse evaluations within CAPNET,
a multicenter child abuse pediatrics research network.
Methods
We conducted a cross-sectional study of children <10 years old who underwent an evaluation
(in-person or remote) by a child abuse pediatrician (CAP) due to concerns for physical
abuse at ten CAPNET hospital systems from February 2021 through December 2021.
Results
Among 3667 patients with 3721 encounters, 69.4% were <3 years old; 44.3% <1 year old,
59.1% male; 27.1% Black; 57.8% White, 17.0% Hispanic; and 71.0 % had public insurance.
The highest level of care was outpatient/emergency department in 60.7%, inpatient
unit in 28.0% and intensive care in 11.4%. CAPs performed 79.1% in-person consultations
and 20.9% remote consultations. Overall, the most frequent injuries were bruises (35.2%),
fractures (29.0%), and traumatic brain injuries (TBI) (16.2%). Abdominal (1.2%) and
spine injuries (1.6%) were uncommon. TBI was diagnosed in 30.6% of infants but only
8.4% of 1-year old children. In 68.2% of cases a report to child protective services
(CPS) was made prior to CAP consultation; in 12.4% a report was made after CAP consultation.
CAPs reported no concern for abuse in 43.0% of cases and mild/intermediate concern
in 22.3%. Only 14.2% were categorized as definite abuse.
Conclusion
Most children in CAPNET were <3 years old with bruises, fractures, or intracranial
injuries. CPS reports were frequently made prior to CAP consultation. CAPs had a low
level of concern for abuse in majority of cases.
Keywords
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References
- Fourth National Incidence Study of Child Abuse and Neglect (NIS-4): Report to Congress.Department of Health & Human Services, 2010
- The economic burden of child maltreatment in the United States and implications for prevention.Child Abuse Negl. 2012; 36: 156-165
U.S. Department of Health & Human Services AfCaF, Administration on Children, Youth and Families, Children's Bureau. Child Maltreatment 2019. 2021.
- Association between pediatric clinical trials and global burden of disease.Pediatrics. 2014; 133: 78-87
- Commentary on: research priorities for a multicenter child abuse pediatrics network - CAPNET by Lindberg D et al., 2017: need for internationally agreed definitions of child maltreatment for research purposes.Child Abuse Negl. 2017; 70: 411-413
- Federal research priorities in child abuse and neglect research: a commentary on multi-site research networks.Child Abuse Negl. 2017; 70: 408-410
- Prevalence of abuse among young children with femur fractures: a systematic review.BMC Pediatr. 2014; 14: 169
- A systematic review of abusive visceral injuries in childhood–their range and recognition.Child Abuse Negl. 2013; 37: 430-445
- What are the clinical and radiological characteristics of spinal injuries from physical abuse: a systematic review.Arch Dis Child. 2010; 95: 355-360
- New Directions in Child Abuse and Neglect Research.The National Academies Press, Washington, DC2013: 7-41
- The Pediatric Emergency Care Applied Research Network (PECARN): rationale, development, and first steps.Pediatr Emerg Care. 2003; 19: 185-193
CPCCRN: Collaborative Pediatric Critical Care Research Network. Explore the publications with which the CPCCRN has been involved. Available at:https://www.cpccrn.org/publications/. Accessed 3/16/18, 2018.
PROS: Pediatric Research in Office Settings. PROS Bibliography. Available at:https://www.aap.org/en-us/professional-resources/Research/PROS/Pages/PROS-Bibliography.aspx. Accessed March 16, 18, 2018.
- Research priorities for a multi-center child abuse pediatrics network - CAPNET.Child Abuse Negl. 2017; 65: 152-157
- The CAPNET multi-center data set for child physical abuse: rationale, methods and scope.Child Abuse Negl. 2022; 105653
- Variability in expert assessments of child physical abuse likelihood.Pediatrics. 2008; 121: e945-e953
CAPNET Definitions Document. Available at: https://digitalrepository.chop.edu/capnet_files/6. Accessed June 24, 2022.
- The prevalence of bruising among infants in pediatric emergency departments.Ann Emerg Med. 2016; 67: 1-8
- Validation of the Pittsburgh infant brain injury score for abusive head trauma.Pediatrics. 2016; 138
- Utility of hepatic transaminases to recognize abuse in children.Pediatrics. 2009; 124: 509-516
- Incidence of serious injuries due to physical abuse in the United States: 1997 to 2009.Pediatrics. 2012; 130: e847-e852
- Using US data to estimate the incidence of serious physical abuse in children.Pediatrics. 2012; 129: 458-464
- Yield of skeletal survey by age in children referred to abuse specialists.J Pediatr. 2014; 164: 1268-1273.e1261
- Variation in occult injury screening for children with suspected abuse in selected US children's hospitals.Pediatrics. 2012;
- Evaluation for occult fractures in injured children.Pediatrics. 2015; 136: 232-240
- Disparities in the evaluation and diagnosis of abuse among infants with traumatic brain injury.Pediatrics. 2010; 126: 408-414
- Racial and ethnic disparities and bias in the evaluation and reporting of abusive head trauma.J Pediatr. 2018; 198: 137-143
- Eliminating disparity in evaluation for abuse in infants with head injury: use of a screening guideline.J Pediatr Surg. 2009; 44 (discussion 1234-1235): 1229-1234
- Racial differences in the evaluation of pediatric fractures for physical abuse.JAMA. 2002; 288: 1603-1609
- Follow-up skeletal survey use by child abuse pediatricians.Child Abuse Negl. 2016; 51: 336-342
- Outcomes for children hospitalized with abusive versus noninflicted abdominal trauma.Pediatrics. 2011; 127: e1400-e1405
- Long-term impact of abusive head trauma in young children: outcomes at 5 and 11 years old.J Pediatr Surg. 2021; 56: 2318-2325
Article info
Publication history
Published online: July 11, 2022
Accepted:
July 4,
2022
Received:
May 22,
2022
Footnotes
Conflict of Interest: Dr. Lindberg has provided paid expert witness testimony in cases with concern for child physical abuse. Drs. Berger's, Campbell's, Letson's, Harper's, Melville's and Wood's institutions have been paid in cases with concern for child physical abuse for which they have provided expert testimony. The other authors report no conflicts of interest.
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