Clinical Decision-Making Case: Non-Accidental Trauma

Area of Science:

• Medical Education
• Pediatric Emergency Medicine
• Clinical Decision-Making

Background:

• Non-accidental trauma (NAT) is a significant cause of pediatric morbidity and mortality.
• Missed abusive injuries can lead to escalating or fatal abuse.
• Timely identification of NAT in acute care is vital for effective intervention.

Purpose of the Study:

• To evaluate emergency medicine residents' ability to diagnose non-accidental trauma using a clinical decision-making case.
• To assess residents' knowledge of historical information, physical exam findings, diagnostic studies, and disposition for suspected pediatric abuse.

Main Methods:

• A clinical decision-making (CDM) case focused on non-accidental trauma was developed for emergency medicine residents.
• Learners were paired with instructors, assessed using a 25-point checklist, and provided feedback.
• Case sessions lasted 20 minutes, including 15 minutes for the case and 5 minutes for debriefing.

Main Results:

• Thirty-nine residents participated, with an average score of 16.85/25.
• Second-year residents (PGY-2) scored higher (18.9) than third-year residents (PGY-3) (18.0) and first-year residents (PGY-1) (14.7).
• Learner feedback suggested widening differential diagnoses and highlighted the importance of caregiver identification.

Conclusions:

• The CDM case is valuable for all levels of emergency medicine residents in identifying high-risk pediatric pathology, particularly non-accidental trauma.
• Performance varied, indicating areas for targeted didactic sessions.
• Formative assessment using this case can enhance learning and improve diagnostic skills for suspected pediatric abuse.