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Pediatric nonaccidental injury: are orthopedic surgeons vigilant enough?
Shay Tenenbaum1, Ran Thein, Amir Herman
1Department of Orthopedic Surgery, The Edmond and Lilly Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel. shayten@gmail.com
Insights
Orthopedic surgeons
Area of Science:
- Orthopedic surgery
- Pediatric medicine
- Child abuse detection
Background:
- Nonaccidental pediatric injuries are a significant cause of child morbidity and mortality.
- Fractures are the second most common presentation of these injuries.
- Orthopedic surgeons play a crucial role in recognizing, treating, and reporting suspected child abuse.
Purpose of the Study:
- To assess the knowledge and attitudes of orthopedic surgeons regarding suspected nonaccidental pediatric injuries.
- To investigate the impact of surgeon experience on their knowledge and practices.
Main Methods:
- A questionnaire was distributed to 130 orthopedic surgeons.
- Data collected included knowledge of pediatric nonaccidental injury, common practices, and reporting attitudes.
- Surgeons' experience levels (≤10 years vs. >10 years) were analyzed for their effect on outcomes.
Main Results:
- 89.2% of surgeons believed it is their responsibility to suspect and report child abuse.
- Less-experienced surgeons were more likely to investigate the cause of symptoms (81.5%) compared to experienced surgeons (61.2%).
- Only 35% of responders had specific training on reporting laws for violence toward minors.
Conclusions:
- Many orthopedic surgeons, regardless of experience, would benefit from enhanced education on pediatric nonaccidental injuries.
- More experienced surgeons showed less awareness and investigative tendency for suspected nonaccidental injuries compared to less experienced ones.
Background:
Nonaccidental pediatric injuries are major cause of morbidity and mortality, with fractures being second to soft-tissue injuries as the most common presentation. As the orthopedic surgeon might be the only physician an abused child would encounter, the role of the orthopedic surgeon is of great importance. It includes recognition, treatment, and appropriate report of suspected child abuse. The purpose of this study is to examine the attitude and knowledge of orthopedic surgeons treating suspected nonaccidental injuries.
Methods:
Evaluation of orthopedic surgeons included level of knowledge regarding pediatric nonaccidental injury, common practice, and reporting attitudes to Child Protection Services. We specifically examined whether seniority and professional experience had effect on knowledge and performance. Data were collected by a questionnaire distributed to orthopedic surgeons.
Results:
The study cohort includes 130 orthopedic surgeons. As much as 62.3% of participating physicians had 10 years or less experience practicing as orthopedic surgeons, and 37.7% had more than 10 years of experience. A mean of 2.39 cases of suspected child abuse was treated over the last year by the physicians that completed the questionnaire. Thirty-five percent of the responders had specific targeted training with respect to the "violence toward minors or helpless reporting obligation law." Of the participating physicians, 89.2% stated that they thought it is the responsibility of the orthopedic surgeons to raise the suspicion for child abuse and refer the child and his/her parents to Child Protection Services. When treating a case of suspected nonaccidental injury, 61.2% of experienced physicians stated that they try to find out what caused the symptoms as opposed to 81.5% of less-experienced physicians (P = 0.011).
Conclusions:
The study findings suggest that many orthopedic surgeons--both senior physicians and less-experienced physicians--can benefit by improved education and training modality related to pediatric nonaccidental injury. More-experienced physicians had lesser awareness and tendency to further investigate cases with suspected nonaccidental injury compared with less-experienced physicians.
Level Of Evidence:
Level III-retrospective study.
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