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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.
Insights
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.
Objectives:
The objectives of this study were to assess the ability of pediatric health care providers and social workers to recognize sentinel injuries in infants under 6 months of age and to determine what factors influence their decision to evaluate for physical abuse.
Methods:
A statewide collaborative focused on sentinel injuries administered a survey to pediatric health care providers and social workers in the emergency department, urgent care, and primary care. The survey contained 8 case scenarios of infants under 6 months of age with an injury, and respondents were asked if they would consider the injury to be a sentinel injury requiring a physical abuse evaluation. Respondents were then presented with several factors and asked how much each influences the decision to perform a physical abuse evaluation.
Results:
A total of 565 providers completed the survey. Providers had moderate interrater reliability on their classification of the cases as sentinel injuries or not (κ = 0.57). Nearly all respondents (97%) recognized genital bruising as a sentinel injury, whereas 77% of respondents recognized intraoral injuries. Agreement was highest among social workers (κ = 0.76) and physicians with categorical pediatrics training and pediatric emergency medicine fellowship (κ = 0.63) and lowest among nurse practitioners (κ = 0.48) and residents (κ = 0.51). Concern over missing the diagnosis of abuse had the greatest influence on the decision to perform a physical abuse evaluation.
Conclusions:
Sentinel injuries are not uniformly recognized as potential signs of child abuse requiring further evaluation by pediatric health care providers. Additional evidence and education are needed regarding sentinel injuries.