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Providers' Ability to Identify Sentinel Injuries Concerning for Physical Abuse in Infants
Emily A Eismann1, Robert A Shapiro, Jonathan Thackeray
1From the Cincinnati Children's Hospital Medical Center.
Pediatric Emergency Care
|August 11, 2018
Summary
Pediatric health care providers have moderate ability to recognize sentinel injuries in infants. Concern over missing abuse diagnoses most influences decisions for physical abuse evaluations.
Area of Science:
- Pediatric Medicine
- Child Abuse Recognition
- Medical Education
Background:
- Sentinel injuries in infants under 6 months are critical indicators of potential physical abuse.
- Early recognition and evaluation are vital for child protection.
Purpose of the Study:
- To assess the recognition of sentinel injuries by pediatric health care providers and social workers.
- To identify factors influencing decisions for physical abuse evaluations in infants.
Main Methods:
- A statewide survey administered to pediatric health care providers and social workers.
- Included 8 case scenarios of infant injuries to assess sentinel injury recognition.
- Assessed the influence of various factors on the decision to evaluate for physical abuse.
Main Results:
- Moderate interrater reliability (κ = 0.57) in classifying sentinel injuries.
- High recognition of genital bruising (97%) but lower for intraoral injuries (77%).
- Social workers and specialized physicians showed higher agreement; nurse practitioners and residents showed lower agreement.
Conclusions:
- Sentinel injury recognition is inconsistent among pediatric health care providers.
- Further education and evidence are needed to improve the identification of sentinel injuries.