Use of Epidemiological Data in the Diagnosis of Physical Child Abuse: Variations in Response to Hypothetical Cases

• NCJ Number: 135781
• Journal: Child Abuse and Neglect Volume: 16 Issue: 1 Dated: (1992) Pages: 45-55
• Author(s): L S Wissow; M E H Wilson
• Date Published: 1992
• Length: 11 pages
• Publication Format: Article
• Publication Type: Research (Applied/Empirical)
• Language: English
• Country: United States of America
• Note: This paper was presented in part at the annual meeting of the American Public Health Association, Chicago, October 24, 1989, and at the First World Conference on Accident and Injury Prevention, Stockholm, September 18, 1989.

Annotation

This study examined whether or not epidemiological data that describe the injuries associated with unintentional trauma could help physicians differentiate intentional from unintentional injury in children, and it also determined whether or not case-specific and physician-specific factors altered how epidemiological data were used.

Abstract

Study subjects were 280 physicians who had registered for an advanced course in pediatric life support. Responses were received from 166 (59 percent); 48 percent were pediatricians, and 37 percent had trained in emergency medicine. Written case vignettes described a child's fall from a highchair. The vignettes systematically varied the type of injury sustained, the presence of a social risk factor, and whether or not the child was monitored by a primary care provider. Vignettes were administered with and without provision of epidemiological data that describe injuries associated with highchair falls. Each study participant received one vignette and was asked to mark on a 0-100 scale their confidence in the injury history given. In vignettes where the presenting injury (femur fracture) would not be expected based on the epidemiological data, the availability of data appropriately decreased confidence that the injury was unintentional. When the presenting injury (skull fracture) matched the epidemiological data, its availability did not alter confidence. The impact of a contrast between presenting injury and epidemiological data varied with specialty; there was a marked drop in confidence among pediatricians, but there was no change among emergency room/intensive care physicians. The article concludes that epidemiological data have the potential to influence physicians decisionmaking in cases of suspected maltreatment, but the impact of such data may vary according to physician specialty. 4 tables, 1 figure, 18 references, and summaries in French and Spanish