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| Child
Abuse CA) Suspicion and Reporting Among Primary Care Practitioners
(PCPs) Emalee G Flaherty, MD 1, Robert Sege, MD, PhD 2, Niramol Dhepyasuwan, MEd 3, Lori L Price, MS 2, Richard Wasserman, MD, MPH 4 and A report from the PROS network 3. 1 Pediatrics, Children's Memorial Hospital/NUMS, Chicago, IL, United States, 60614; 2 Pediatrics, Floating Hospital for Children, Boston, MA, United States, 02111; 3 PROS, American Academy of Pediatrics, Elk Grove Village, IL, United States, 60007 and 4 Pediatrics, U of Vermont, Burlington, VT, United States, 05401. Background: Relatively few cases of CA are reported from primary care settings. The paucity of reports may result if CA is rarely seen in primary care, if CA is seen but not recognized, or if seen and recognized but not reported. Objective: 1) To determine frequency of suspicion for CA among PCPs. 2) To examine the association between level of suspicion and practitioner reports made to child protective services (CPS). Design/Methods: 424 Pediatric Research in Office Setting (PROS) Network PCPs each collected information about 40 consecutive children having an injury (injury defined as one worthy of notation in the chart, suspected sexual abuse excluded). PCPs indicated their suspicion that injury was caused by CA on a Likert scale (Very Unlikely, Unlikely, Possible, Likely, Very Likely). They were also asked if they had reported suspected abuse (Yes or No) to CPS. Results: The results of 14,023 office-based
injury visits were analyzed. After excluding 65 (0.5%) injuries previously
reported to CPS, PCPs suspected that 87 (0.6%) of the injuries were
likely or very likely to have been caused by abuse. They reported
51 (58.6%) of these suspicious injuries to CPS. The median age of
children reported to CPS was 3 years, younger than the median age
of children not reported (8 years; p=0.0001). Those deemed very likely
CA were less likely to be reported than those deemed likely CA. Conclusions: The evidence is that
abuse is suspected fairly frequently (1/160 injured children deemed
likely or very likely abused). Children in this likely/very likely
category were reported only slightly more than half the time to CPS.
Research is being conducted that will describe how these unreported
children are managed and the consequences of this high level of under-reporting.
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