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Bruising in Children: Practice Patterns of Pediatric Hematologists and Child Abuse Pediatricians
Jami Jackson1, Melissa Miller2, Mary Moffatt2
1Children's Mercy Hospitals and Clinics, Kansas City, MO, USA jtjackson@cmh.edu.
Insights
Referral specialty impacts evaluation for children with bruising. Pediatric Hematology focused on lab tests, while Child Abuse Pediatrics (CAP) utilized imaging, leading to distinct diagnoses like bleeding disorders or child abuse.
Area of Science:
- Pediatric Medicine
- Medical Diagnostics
- Child Welfare
Background:
- Bruising in children can indicate abuse or medical conditions.
- Specialty referral influences diagnostic approaches.
- Child Abuse Pediatrics (CAP) and Pediatric Hematology have distinct evaluation protocols.
Purpose of the Study:
- To compare diagnostic evaluations and diagnoses for children referred for bruising.
- To identify characteristics associated with referral to CAP versus Pediatric Hematology.
- To understand how specialty influences the workup and conclusions for pediatric bruising.
Main Methods:
- Retrospective review of 369 children referred for bruising over 3 years.
- Analysis of referral patterns to Child Abuse Pediatrics (CAP) and Pediatric Hematology.
- Comparison of clinical findings, laboratory tests, and imaging studies between groups.
Main Results:
- Referrals to CAP (275) and Hematology (94) showed similar clinical findings but different evaluations.
- Hematology referrals underwent more laboratory tests; CAP referrals underwent imaging (CT scans, skeletal surveys).
- Hematology never diagnosed abuse; CAP never diagnosed bleeding disorders, indicating divergent diagnostic outcomes.
Conclusions:
- Pediatric Hematologists and CAP specialists conduct different evaluations for similar pediatric bruising cases.
- Specialty significantly impacts diagnostic conclusions, with distinct diagnoses for each group.
- Further investigation into these differing practice patterns is warranted to optimize child evaluation.
Abstract:
The evaluation for children with bruising may be affected by the specialty to which they are referred. We conducted a 3-year retrospective review of subjects referred for bruising to Child Abuse Pediatrics (CAP) or Pediatric Hematology to identify characteristics associated with referral to each specialty and to compare the diagnostic evaluations and diagnoses based on specialty. Of 369 subjects, 275 were referred to CAP and 94 to Hematology. Clinical exam findings were similar in both groups. Hematology referrals were significantly more likely to have laboratory evaluations. Among those referred to CAP, 9.5% had head computed tomography scans and 27.3% had skeletal surveys. No children referred to Hematology had these imaging studies performed. Hematology never diagnosed child physical abuse, and CAP never diagnosed bleeding disorders. Pediatric hematologists and CAPs perform different evaluations and reach different diagnostic conclusions for similar patients with bruising. Further investigation of these practice patterns is warranted.
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