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Classifying Injuries in Young Children as Abusive or Accidental: Reliability and Accuracy of an Expert Panel Approach
Douglas J Lorenz1, Mary Clyde Pierce2, Kim Kaczor3
1Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY.
Insights
An expert panel demonstrated high reliability and accuracy in distinguishing abusive from accidental injuries in young children. This multidisciplinary approach provides a dependable standard for pediatric injury classification.
Area of Science:
- Pediatric Emergency Medicine
- Forensic Pediatrics
- Child Abuse and Neglect Research
Background:
- Accurate classification of pediatric injuries is crucial for timely intervention and protection of children.
- Distinguishing between abusive and accidental injuries can be challenging, necessitating reliable diagnostic tools.
Purpose of the Study:
- To evaluate the interrater reliability and accuracy of a multidisciplinary expert panel in classifying pediatric injuries.
- To establish a criterion standard for differentiating abusive from accidental injuries in young children.
Main Methods:
- A prospective, observational, multicenter study enrolled 2166 children under 4 years with identified bruises.
- A 9-member expert panel assessed deidentified case information using a 5-level scale for abuse likelihood and recommended child protective services (CPS) reporting.
- Interrater reliability was calculated using Kendall's coefficient and kappa statistics.
Main Results:
- High interrater reliability was observed, with Kendall's coefficient for abuse likelihood at 0.89 and kappa for CPS reporting at 0.91.
- Reliability remained high across pairs and subgroups of panelists.
- The panel's composite classification showed near-perfect accuracy in cases with confirmed injury status.
Conclusions:
- A multidisciplinary expert panel serves as a reliable and accurate criterion standard for classifying pediatric injuries.
- This approach is effective for children presenting with injuries to pediatric emergency departments.
- The findings support the use of expert consensus in complex pediatric injury evaluations.
Objective:
To assess interrater reliability and accuracy of an expert panel in classifying injuries of patients as abusive or accidental based on comprehensive case information.
Study Design:
Data came from a prospective, observational, multicenter study investigating bruising characteristics of children younger than 4 years. We enrolled 2166 patients with broad ranges of illnesses and injuries presenting to one of 5 pediatric emergency departments in whom bruises were identified during examination. We collected comprehensive data regarding current and past injuries and illnesses, and provided deidentified, standardized case information to a 9-member multidisciplinary panel of experts with extensive experience in pediatric injury. Each panelist classified cases using a 5-level ordinal scale ranging from definite abuse to definite accident. Panelists also assessed whether report to child protective services (CPS) was warranted. We calculated reliability coefficients for likelihood of abuse and decision to report to CPS.
Results:
The interrater reliability of the panelists was high. The Kendall coefficient (95% CI) for the likelihood of abuse was 0.89 (0.87, 0.91) and the kappa coefficient for the decision to report to CPS was 0.91 (0.87, 0.94). Reliability of pairs and subgroups of panelists were similarly high. A panel composite classification was nearly perfectly accurate in a subset of cases having definitive, corroborated injury status.
Conclusions:
A panel of experts with different backgrounds but common expertise in pediatric injury is a reliable and accurate criterion standard for classifying pediatric injuries as abusive or accidental in a sample of children presenting to a pediatric emergency department.
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