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A standardized definition of near-fatal child maltreatment: Results of a multidisciplinary Delphi process
Kristine A Campbell1, Joanne N Wood2, Daniel M Lindberg3
1Department of Pediatrics, Division of Child Protection and Family Health, University of Utah, Salt Lake City, Utah 84115, United States; The Center for Safe and Healthy Families, Primary Children's Hospital, Salt Lake City, Utah 84115, United States.
Background:
The 2016 Presidential Commission to Eliminate Child Abuse and Neglect Fatalities identified systematic review of all cases of near-fatal child maltreatment as a necessary step towards prevention of child maltreatment fatalities. A critical barrier to adoption of this recommendation is the lack of a standard definition of "near-fatality" in the context of suspected child maltreatment.
Objective:
To develop a consensus definition of near-fatal child maltreatment to be used in practice, policy, and research.
Participants And Setting:
A multidisciplinary expert panel of 23 individuals from across the U.S. including child abuse pediatricians, pediatric intensivists, pediatric emergency medicine physicians, child welfare administrators, child welfare researchers, and child injury/fatality researchers.
Methods:
A modified Delphi process reflecting an iterative process of 3 rounds of surveys of expert opinion, statistical summary of survey response, and feedback of summary statistics. Consensus was defined as 75 % of panelists ranking an element as required (≥80 on a scale of 0-100) to meet a definition of near-fatality (75th% threshold).
Results:
Experts defined near-fatal child maltreatment as life-threatening cardiopulmonary dysfunction directly attributable to suspected abuse or neglect as evidenced by (a) respiratory insufficiency/failure requiring intubation and mechanical ventilation, (b) respiratory insufficiency/failure requiring medications to reverse effects of toxic ingestion, or (c) cardiac arrhythmia with/without cardiopulmonary resuscitation (CPR).
Conclusions:
A consensus definition of near-fatal child maltreatment should be introduced in child protective services processes and in child fatality/near-fatality reviews to improve our ability to identify, review, and respond to trends in near-fatal child maltreatment at local, regional, and national levels.
