Kristine A Campbell1, Joanne N Wood2, Daniel M Lindberg3, Rachel P Berger4. 1. Department of Pediatrics, Division of Child Protection and Family Health, University of Utah, Salt Lake City, Utah 84115, United States; The Center for Safe and Healthy Families, Primary Children's Hospital, Salt Lake City, Utah 84115, United States. Electronic address: kristine.campbell@hsc.utah.edu. 2. Safe Place: The Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States. 3. University of Colorado Anschutz Medical Campus, Aurora, CO, United States; Department of Emergency Medicine, Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, United States. 4. Department of Pediatrics, UPMC Children's Hospital of Pittsburgh Pittsburgh, PA, United States.
Abstract
BACKGROUND: The 2016 Presidential Commission to Eliminate Child Abuse and Neglect Fatalities identified systematic review of all cases of near-fatal child maltreatment as a necessary step towards prevention of child maltreatment fatalities. A critical barrier to adoption of this recommendation is the lack of a standard definition of "near-fatality" in the context of suspected child maltreatment. OBJECTIVE: To develop a consensus definition of near-fatal child maltreatment to be used in practice, policy, and research. PARTICIPANTS AND SETTING: A multidisciplinary expert panel of 23 individuals from across the U.S. including child abuse pediatricians, pediatric intensivists, pediatric emergency medicine physicians, child welfare administrators, child welfare researchers, and child injury/fatality researchers. METHODS: A modified Delphi process reflecting an iterative process of 3 rounds of surveys of expert opinion, statistical summary of survey response, and feedback of summary statistics. Consensus was defined as 75 % of panelists ranking an element as required (≥80 on a scale of 0-100) to meet a definition of near-fatality (75th% threshold). RESULTS: Experts defined near-fatal child maltreatment as life-threatening cardiopulmonary dysfunction directly attributable to suspected abuse or neglect as evidenced by (a) respiratory insufficiency/failure requiring intubation and mechanical ventilation, (b) respiratory insufficiency/failure requiring medications to reverse effects of toxic ingestion, or (c) cardiac arrhythmia with/without cardiopulmonary resuscitation (CPR). CONCLUSIONS: A consensus definition of near-fatal child maltreatment should be introduced in child protective services processes and in child fatality/near-fatality reviews to improve our ability to identify, review, and respond to trends in near-fatal child maltreatment at local, regional, and national levels.
BACKGROUND: The 2016 Presidential Commission to Eliminate Child Abuse and Neglect Fatalities identified systematic review of all cases of near-fatal child maltreatment as a necessary step towards prevention of child maltreatment fatalities. A critical barrier to adoption of this recommendation is the lack of a standard definition of "near-fatality" in the context of suspected child maltreatment. OBJECTIVE: To develop a consensus definition of near-fatal child maltreatment to be used in practice, policy, and research. PARTICIPANTS AND SETTING: A multidisciplinary expert panel of 23 individuals from across the U.S. including child abuse pediatricians, pediatric intensivists, pediatric emergency medicine physicians, child welfare administrators, child welfare researchers, and child injury/fatality researchers. METHODS: A modified Delphi process reflecting an iterative process of 3 rounds of surveys of expert opinion, statistical summary of survey response, and feedback of summary statistics. Consensus was defined as 75 % of panelists ranking an element as required (≥80 on a scale of 0-100) to meet a definition of near-fatality (75th% threshold). RESULTS: Experts defined near-fatal child maltreatment as life-threatening cardiopulmonary dysfunction directly attributable to suspected abuse or neglect as evidenced by (a) respiratory insufficiency/failure requiring intubation and mechanical ventilation, (b) respiratory insufficiency/failure requiring medications to reverse effects of toxic ingestion, or (c) cardiac arrhythmia with/without cardiopulmonary resuscitation (CPR). CONCLUSIONS: A consensus definition of near-fatal child maltreatment should be introduced in child protective services processes and in child fatality/near-fatality reviews to improve our ability to identify, review, and respond to trends in near-fatal child maltreatment at local, regional, and national levels.
Authors: Caitlin A Farrell; Eric W Fleegler; Michael C Monuteaux; Celeste R Wilson; Cindy W Christian; Lois K Lee Journal: Pediatrics Date: 2017-05 Impact factor: 7.124