The use of consumer injury registry data to evaluate physical abuse

Health care workers called upon to evaluate trauma in children must frequently decide if a given injury may have been intentionally inflicted. Some injuries are considered to be virtually diagnostic of abuse, but most are not at present readily associated with a particular type of intentional or nonintentional trauma. This study presents an example of how epidemiologically derived injury pattern data might be used by health care workers to better detect cases where intentional injury may have occurred. Injury pattern data were obtained for one type of trauma, falls from children's highchairs, from the U.S. Consumer Product Safety Commission (CPSC). Medical personnel at four training levels were randomized to receive a case description, which included an account of a fall from a highchair as the explanation of an injury, with or without the CPSC data. The injury described in the case was not one found in the CPSC pattern data. They were subsequently asked about their confidence in the explanation given and their desire to make a report of suspected abuse. Respondents given the CPSC data appropriately had less confidence in the explanation (p less than .001), although both groups felt strongly that a report should be made. Decreased confidence was demonstrated at all training levels. We concluded that clinicians could make use of injury pattern data in their examination of trauma cases, although such data cannot substitute for a thorough medical and social evaluation.