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Published on: February 23, 2024
Exploring the acceptability of a clinical decision rule to identify paediatric burns due to child abuse or neglect
Emma Louise Johnson1, Linda Irene Hollén2, Alison Mary Kemp3
1College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
Insights
Clinicians find a new clinical decision rule (CDR) for identifying child maltreatment burns useful and are likely to follow its recommendations. Implementation should consider training and rule background to maximize uptake.
Area of Science:
- Medical research
- Clinical practice guidelines
- Child protection
Background:
- A clinical decision rule (CDR) was developed using systematic review and epidemiological data to identify burns resulting from child maltreatment (abuse or neglect).
- This study explored healthcare professionals' perspectives on the CDR before a full implementation evaluation.
Purpose of the Study:
- To assess clinicians' views on a newly developed CDR for identifying child maltreatment burns.
- To determine the likelihood of the CDR influencing clinical management decisions.
- To identify factors affecting the acceptability and uptake of the CDR.
Main Methods:
- A semistructured questionnaire was administered to 55 doctors and nurses across emergency departments and burns units.
- Participants' views on the CDR, data collection, and recognition of maltreatment (via vignettes) were assessed.
- Statistical analysis included Fisher's exact test and coefficient of unalikeability for variability.
Main Results:
- 81.8% (45/55) of participants found the CDR and data collection useful.
- Only 9.3% (5/54) of clinicians indicated they would not follow the CDR's recommended actions.
- Lower-grade doctors were more likely to adhere to CDR recommendations (p=0.04) than senior doctors, who would consider it in their decision-making.
Conclusions:
- Clinicians are receptive to using a CDR to aid in identifying burns related to child maltreatment.
- Successful implementation requires addressing key factors such as training, understanding the rule's development, and clear action protocols to maximize adoption.
Objective:
An evidence based clinical decision rule (CDR) was developed from a systematic review and epidemiological study to identify burns due to child maltreatment (abuse or neglect). Prior to an implementation evaluation, we aim to explore clinicians' views of the CDR, the likelihood that it would influence their management and factors regarding its acceptability.
Methods:
A semistructured questionnaire exploring demographics, views of the CDR and data collection pro forma, ability to recognise maltreatment and likelihood of following CDR recommended child protection (CP) action, was administered to 55 doctors and nurses in eight emergency departments and two burns units. Recognition of maltreatment was assessed via four fictitious case vignettes.
Analysis:
Fisher's exact test and variability measured by coefficient of unalikeability.
Results:
The majority of participants found the CDR and data collection pro forma useful (45/55, 81.8%). Only five clinicians said that they would not take the action recommended by the CDR (5/54, 9.3%). Lower grade doctors were more likely to follow the CDR recommendations (p=0.04) than any other grade, while senior doctors would consider it within their decision making. Factors influencing uptake include: brief training, background to CDR development and details of appropriate actions.
Conclusions:
It is apparent that clinicians are willing to use a CDR to assist in identifying burns due to child maltreatment. However, it is clear that an implementation evaluation must encompass the influential variables identified to maximise uptake.
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