A Comparison of Pediatric Resident and Practitioner Identification and Management of Suspected Child Abuse

L Rizzardini¹, ML Angelilli², LL Price³, RD Sege³, K OConnor⁴ and E Flaherty⁵. ¹Pediatric Research in Office Settings (PROS), Department of Practice & Research, American Academy of Pediatrics, Elk Grove Village, IL; ²Pediatrics, Children?s Hospital of Michigan/Wayne State, Detroit, MI; ³Pediatric and Adolescent Health Research Center, Floating Hospital for Children/Tufts-NEMC, Boston, MA; ⁴Division of Health Policy Research, American Academy of Pediatrics, Elk Grove Village, IL and ⁵Pediatrics, Children?s Memorial Hospital/Northwestern U Feinberg School of Medicine, Chicago, IL.

 

Background: Child maltreatment causes significant childhood mortality and morbidity. Pediatricians often gain their first experience evaluating abuse during their residency.

 

Objective: To compare residents and practicing pediatricians a) assessment of suspicion that an injury was caused by abuse, b) referral pattern, and c) decision to report to child protective services (CPS).

 

Design/Methods: An AAP Periodic Survey was mailed in 2003 to a random sample of 1603 U.S. members (response=851; 53%). The survey included a purposely ambiguous clinical vignette describing an injury that could be suspicious for child abuse. The respondents (101 residents and 668 practicing pediatricians) indicated their suspicion that an injury was caused by abuse, their choice of referral, and whether they would report to CPS. They also rated the adequacy of their training about child abuse.

 

Results: The residents were more likely to practice in the inner city than pediatric practitioners (52% vs. 20%; p=<.0001). The residents were more likely than the practicing pediatricians to suspect that an injury was caused by abuse (52% vs. 37%; p=.009). In addition, 78% of the residents compared to 70% of the practicing pediatricians would have reported the child to CPS, but these differences were not statistically significant. The residents differed in their referral patterns. They were more likely than practicing pediatricians to consult a colleague (34% vs. 23%; p=.02) and a child abuse team (95% vs. 83%; p=.002), while practicing pediatricians were more likely to refer to an orthopedics specialist (50% vs. 38%; p=.02) or to make no referral (5% vs. 0%: p=.01). The residents saw a higher median number of children with suspicious injuries in the previous year (4 v. 2; p<.0001). Residents and practicing pediatricians perceptions of the adequacy of their professional training in child abuse was comparable.

 

Conclusions: Compared to practicing pediatricians, pediatric residents are more likely to suspect that the injury described in the vignette was caused by abuse and more likely to consult child abuse teams, but are not more likely to report the injury to CPS. Availability of child abuse consultation, peers, and supervisors are likely factors in these behaviors.