Testing for bleeding disorders in child abuse: AAP recommendation adherence and testing results.

Area of Science:

• Pediatric Medicine
• Child Abuse Pediatrics
• Hematology

Background:

• Child abuse evaluations often involve assessing for underlying medical conditions.
• The American Academy of Pediatrics (AAP) provides guidelines for bleeding disorder testing in suspected abuse cases.
• Variability in adherence to these guidelines may impact diagnosis and care.

Purpose of the Study:

• To evaluate adherence to AAP bleeding disorder testing recommendations in children with suspected abuse.
• To determine the frequency of bleeding disorder identification in this population.
• To analyze variations in testing practices across different centers.

Main Methods:

• A descriptive study was conducted using data from the Child Abuse Pediatrics Network (CAPNET).
• Children under 10 years with bruising and/or intracranial hemorrhage (ICH) concerning for abuse were included.
• Adherence to AAP testing recommendations and the rate of bleeding disorder identification were primary outcomes.

Main Results:

• 2491 children were analyzed; 25.1% met AAP criteria for testing.
• Testing completion rates were low: 10.5% for bruising and 33.1% for ICH.
• Bleeding disorders were identified in 0.7% of cases, with higher rates at centers with increased testing.

Conclusions:

• Adherence to AAP bleeding disorder testing guidelines in suspected child abuse cases is inconsistent and varies significantly by center.
• While rare, bleeding disorders are present in this patient population.
• Standardized implementation of AAP guidelines may improve diagnostic yield.