Child Welfare

Occult Injury Screening and the Detection of Physical Abuse in Young Children

Research Lead: Joanne N. Wood MD, MSHP
Sponsored By: Eunice Kennedy Shriver National Institute of Child Health & Human Development
Dates: April 2012 – March 2017

Background

Annually, over 120,000 children are substantiated as victims of physical abuse in the U.S., but the true incidence is likely higher.  A major challenge in diagnosing abuse in young injured children is occult injuries that are revealed only on screening imaging studies.  Research has shown variations in rates of occult injury screening and child abuse diagnosis based on patient socio-demographic characteristics and site of medical care.  However, efforts to address these disparities and improve the quality of care have been hindered by lack of clear criteria regarding the appropriate use of occult injury screening.

Aims

• Develop and validate appropriateness criteria for performing occult injury screening in young injured children
• Construct and validate a set of algorithms for assessing the appropriateness of screening for occult injuries that can be applied to administrative data
• Examine occult injury screening practices using administrative data algorithms in a large database of pediatric hospitals
• Identify factors that promote appropriate use, overuse, and underuse of occult injury screening

Methods

Study Design: Using a modified Delphi procedure, a multi-specialty expert panel will develop a set of appropriateness criteria for performing occult injury screening.  The appropriateness criteria will be used to develop algorithms that can be applied to administrative data to assess the appropriateness of occult injury screening.  These algorithms will be used to assess the level of occult injury screening in hospitals.  Finally, qualitative techniques will be used in outlier hospitals to identify best practices for occult injury screening and barriers preventing optimal screening practices.

Progress

The development of the appropriateness criteria is currently underway.

Policy Focus

This research program utilizes an innovative approach to address the observed disparities and quality concerns around screening practices for occult injuries in young injured children.  Results from these studies can inform medical recommendations and policy efforts to provide evidence-based tools for identifying and diagnosing child physical abuse.

Resources

ACR. ACR practice guideline for skeletal surveys in children. Reston, VA; 2006.

American Academy of Pediatrics. Diagnostic imaging of child abuse. Pediatrics. 2009;123(5):1430-1435.

Kellogg ND. Evaluation of suspected child physical abuse. Pediatrics. 2007;119(6):1232-1241.

Oral R, Blum KL, Johnson C. Fractures in young children: are physicians in the emergency department and orthopedic clinics adequately screening for possible abuse? Pediatr Emerg Care. 2003;19(3):148-153.

Rangel EL, Cook BS, Bennett BL, Shebesta K, Ying J, Falcone RA. Eliminating disparity in evaluation for abuse in infants with head injury: use of a screening guideline. J Pediatr Surg. 2009;44(6):1229-1234; discussion 1234-1235.

Ravichandiran N, Schuh S, Bejuk M, Al-Harthy N, Shouldice M, Au H, et al. Delayed identification of pediatric abuse-related fractures. Pediatrics. 2010;125(1):60-66.

Wood JN, Hall M, Schilling S, Keren R, Mitra N, Rubin DM. Disparities in the evaluation and diagnosis of abuse among infants with traumatic brain injury. Pediatrics. 2010;126(3):408-414.