The Use of Experts to Evaluate a Child Abuse Guideline in Community Emergency Departments
| Autor: | Julie R. Gaither, May Shum, Andrea G. Asnes, John M. Leventhal, Kirsten Bechtel, Gunjan Tiyyagura |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Child abuse
medicine.medical_specialty Skeletal survey Psychological intervention 03 medical and health sciences 0302 clinical medicine Clinical pathway 030225 pediatrics Humans Medicine Child Abuse 030212 general & internal medicine Child Referral and Consultation Retrospective Studies business.industry Child Protective Services Infant Guideline Emergency department Test (assessment) Child protection Family medicine Pediatrics Perinatology and Child Health Emergency Service Hospital business |
| Zdroj: | Academic Pediatrics. 21:521-528 |
| ISSN: | 1876-2859 |
| DOI: | 10.1016/j.acap.2020.11.001 |
| Popis: | Guidelines and pathways exist to help frontline providers evaluate injured children for suspected child abuse. Little, however, is known about whether the decision-making resulting from these interventions is correct. Therefore, in the absence of an available gold-standard test, we used experts' judgments to examine the appropriateness of these clinical decisions. We evaluated community emergency department (ED) providers' adherence to a guideline recommending a child protection team (CPT) consultation for infants with injuries associated with abuse. We then compared providers' decision-making to experts' recommendations before and after guideline implementation.Two experts conducted a blinded, retrospective review of injured infants from 3 community EDs (N = 175). Experts rated the likelihood that an injury was abusive, indeterminate, or accidental, and made recommendations that were compared with skeletal survey (SS) testing and child protective services (CPS) reporting by providers before and after guideline implementation.Postguideline implementation, there was a significant increase in CPT consultations in indeterminate cases (14.3% vs 72.2%, P.001) and in SS testing when experts recommended SS (20.6% vs 56.8%, P = .002). In contrast, a higher percentage of cases for whom the experts did not recommend reporting were reported to CPS (1.8% vs 14.6%, P = .02).Providers consulted the CPT most often for indeterminate cases. SS testing was in line with expert recommendations, but CPS reporting diverged from expert recommendations. Interventions linking community ED providers with a CPT may improve the evaluation of infants with injuries concerning for abuse. |
| Databáze: | OpenAIRE |
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