OBJECTIVE: Diagnosis of child abuse is difficult and may reflect patient, practitioner, and system factors. Previous studies have demonstrated potential lethal consequences if cases of abuse are missed and suggested a role for continuing medical education in improving the accuracy of diagnosis of suspected abuse. Although the majority of injured American children are treated at general hospitals, most published studies of severe injury resulting from child abuse have been conducted at children's hospitals. The objective of this study was to evaluate the role of hospital type in observed variations in the frequency of diagnosis of child physical abuse among children with high-risk injuries. METHODS: Hospital discharge data were evaluated, and adjusted rates of abuse diagnosis were reported according to hospital type. A regression model estimated the number of cases of abuse that would have been diagnosed if all hospitals identified abuse as frequently as observed at pediatric specialty hospitals. This study consisted of children who were <1 year old and admitted to US hospitals in 1997 for treatment of traumatic brain injury or femur fracture, excluding penetrating trauma or motor-vehicle-related injury. A total of 2253 weighted cases were analyzed. RESULTS: The proportion of patients with a medical diagnosis of child abuse varied widely between hospital types: 29% of the cases were diagnosed as abuse at children's hospitals compared with 13% at general hospitals. An estimated 178 infants (39% of total) with these specific injuries would have been identified as abused had they been treated at children's rather than general hospitals. CONCLUSIONS: Hospital type was associated with large variations in the frequency of diagnosis of child abuse. This variation was not related to observed differences in the patients or their injuries and may result from systematic underdiagnosis in general hospitals. This result has implications for quality-improvement programs at general hospitals, where the majority of injured children in the United States receive emergent medical care.
OBJECTIVE: Diagnosis of child abuse is difficult and may reflect patient, practitioner, and system factors. Previous studies have demonstrated potential lethal consequences if cases of abuse are missed and suggested a role for continuing medical education in improving the accuracy of diagnosis of suspected abuse. Although the majority of injured American children are treated at general hospitals, most published studies of severe injury resulting from child abuse have been conducted at children's hospitals. The objective of this study was to evaluate the role of hospital type in observed variations in the frequency of diagnosis of child physical abuse among children with high-risk injuries. METHODS: Hospital discharge data were evaluated, and adjusted rates of abuse diagnosis were reported according to hospital type. A regression model estimated the number of cases of abuse that would have been diagnosed if all hospitals identified abuse as frequently as observed at pediatric specialty hospitals. This study consisted of children who were <1 year old and admitted to US hospitals in 1997 for treatment of traumatic brain injury or femur fracture, excluding penetrating trauma or motor-vehicle-related injury. A total of 2253 weighted cases were analyzed. RESULTS: The proportion of patients with a medical diagnosis of child abuse varied widely between hospital types: 29% of the cases were diagnosed as abuse at children's hospitals compared with 13% at general hospitals. An estimated 178 infants (39% of total) with these specific injuries would have been identified as abused had they been treated at children's rather than general hospitals. CONCLUSIONS: Hospital type was associated with large variations in the frequency of diagnosis of child abuse. This variation was not related to observed differences in the patients or their injuries and may result from systematic underdiagnosis in general hospitals. This result has implications for quality-improvement programs at general hospitals, where the majority of injured children in the United States receive emergent medical care.
Authors: Gunjan Tiyyagura; Andrea G Asnes; John M Leventhal; Amy Shah; Trisha Calabrese; Linda Radecki; Gloria Jeter; Marc Auerbach Journal: Acad Pediatr Date: 2019-07-09 Impact factor: 3.107
Authors: M Katherine Henry; Mark R Zonfrillo; Benjamin French; Lihai Song; Chris Feudtner; Joanne N Wood Journal: Acad Pediatr Date: 2016-02-04 Impact factor: 3.107
Authors: Joanne N Wood; Oludolapo Fakeye; Chris Feudtner; Valerie Mondestin; Russell Localio; David M Rubin Journal: Pediatrics Date: 2014-06-16 Impact factor: 7.124
Authors: Gunjan Tiyyagura; Paula Schaeffer; Marcie Gawel; John M Leventhal; Marc Auerbach; Andrea G Asnes Journal: Acad Pediatr Date: 2019-01-29 Impact factor: 3.107
Authors: Joanne N Wood; Chris Feudtner; Sheyla P Medina; Xianqun Luan; Russell Localio; David M Rubin Journal: Pediatrics Date: 2012-10-15 Impact factor: 7.124
Authors: Mary A Kernic; Frederick P Rivara; Douglas F Zatzick; Michael J Bell; Mark S Wainwright; Jonathan I Groner; Christopher C Giza; Richard B Mink; Richard G Ellenbogen; Linda Boyle; Pamela H Mitchell; Nithya Kannan; Monica S Vavilala Journal: J Neurotrauma Date: 2013-06-25 Impact factor: 5.269
Authors: Tony Rosen; Elizabeth M Bloemen; Veronica M LoFaso; Sunday Clark; Neal E Flomenbaum; Mark S Lachs Journal: J Emerg Med Date: 2016-01-22 Impact factor: 1.484