An injury plausibility assessment model for differentiating abusive from accidental fractures in young children

区分幼儿虐待和意外骨折的伤害合理性评估模型

• 批准号: 10440510
• 负责人: GINA E. BERTOCCI
• 金额: $ 66.66万
• 依托单位: LURIE CHILDREN'S HOSPITAL OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-04 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10440510
• 关键词: 3 year old; Abdominal Injuries; Abuse Reporting; Accidental Injury; Accidents; Address; Age; Biomechanics; Biometry; Bone Diseases; Cessation of life; Child; Child Abuse; Child Abuse and Neglect; Childhood; Consultations; Dangerousness; Data Set; Decision Making; Diagnosis; Emergency Medicine; Emergency department visit; Environment; Epidemic; Ethnic Origin; Ethnic group; Evaluation; Evaluation Reports; Family; Fracture; Future; Goals; Hispanic; Hispanic Populations; Injury; Investigation; Lead; Life; Light; Medical; Minority; Modeling; Multicenter Studies; Musculoskeletal; Not Hispanic or Latino; Observational Study; Occult Fractures; Orthopedic Surgery; Osteogenesis Imperfecta; Outcome; Outcome Measure; Patients; Performance; Pilot Projects; Provider; Public Health; Race; Radiology Specialty; Recording of previous events; Reference Standards; Reporting; Research Personnel; Rickets; Risk; Risk Factors; Sampling; Screening procedure; Skeletal Survey; Skin; Social Work; Specificity; Testing; Time; Trauma; Traumatic Brain Injury; United States; Validation; Visit; Work; base; bone health; care seeking; child physical abuse; child protective service; clinical decision-making; cohort; cost; ethnic disparity; ethnic minority population; evidence base; high risk; improved; long bone; multidisciplinary; physical abuse; prospective; psychosocial; racial and ethnic disparities; success

PROJECT SUMMARY / ABSTRACT Child abuse is a public health epidemic with devastating consequences for young children. In 2017, there were 676,000 victims of child abuse and neglect in the United States including approximately 1700 deaths. Young children are especially vulnerable - 81% of these deaths occurred among children 0-3 years old. Physical child abuse results in over 120,000 cases a year (less than a quarter of all abuse cases), but accounts for over half of the deaths, speaking to the heightened risk for a child. Fractures are the most common serious injury from physical abuse, occurring more often than abuse-related traumatic brain injury and abdominal injury combined. Each year in the United States there are more than 90,000 emergency department visits for fractures in children age 0-5 years (most often involving the long bones), with abuse-related fractures peaking in the first 3 years of life. It can be extremely difficult for providers to differentiate abuse-related fractures from those associated with an accident in these young children. This difficulty results in a bidirectional problem: under evaluation and missed abuse for some (which may result in re-injury or even death), and over evaluation for abuse and reporting to state child protective services (CPS) for others (which also impacts families negatively, and occurs most often in race/ethnic minority groups). Such “bidirectional” errors in decision making come at a high cost to all involved. These issues highlight the critical need for an evidence-based fracture assessment model to inform medical decision-making when attempting to differentiate abusive from accidental fractures. To address this need, we developed and tested a fracture injury plausibility assessment model (FxIPAM) in 201 children with long bone fractures. We demonstrated its capability to differentiate abuse-related fractures from those resulting from accidental trauma and also demonstrated its theoretical potential to decrease race/ethnic disparities in rates of abuse evaluations, based on model scoring results. Before implementation, validation is required. The goal of this study is to validate an evidence-based model for fracture assessments to improve the clinician’s ability to differentiate abuse from accidental fractures in young children. Therefore, we propose the following aims in a prospective multicenter study of 1000 children, 0-3 years of age, with a long bone fracture: 1) Validate our FxIPAM model by determining its predictive accuracy to differentiate between abuse vs. accidental long bone fractures, and 2) estimate the impact of a hypothetical application of the FxIPAM on abuse assessments and reporting to CPS across race/ethnic groups. Success of this study will result in the first validated model for fracture assessments in young children. The intent of the FxIPAM is not to diagnose abuse but to function as a screening tool to identify children at risk for abuse who require further evaluation and to identify children with plausible injuries where further work for abuse or reporting to CPS may not be require. The potential public health impact of this model is bidirectional: decreased missed abuse and decreased disparities in abuse evaluations and reporting to CPS.

项目摘要/摘要 虐待儿童是一种公共卫生流行病，对幼儿具有毁灭性的后果。2017年，有 美国676,000名虐待和忽视儿童的受害者，其中约有1,700人死亡。年青的 儿童尤其脆弱--81%的死亡发生在0-3岁儿童中。体格儿童 虐待每年导致超过12万起案件(不到所有虐待案件的四分之一)，但占一半以上 死亡人数，说明了儿童面临的高风险。骨折是最常见的严重损伤 由于身体虐待，比与虐待有关的创伤性脑损伤和腹部损伤更容易发生 加在一起。在美国，每年有超过9万人次的急诊科就诊 0-5岁儿童骨折(最常累及长骨)，与虐待有关的骨折达到顶峰 在生命的前三年。对于提供者来说，区分与虐待相关的骨折和 那些与这些年幼儿童的意外有关的人。此困难导致双向问题： 评价过低和一些人错过了虐待(这可能导致再次受伤甚至死亡)，以及评价过高 因虐待和向州儿童保护服务机构(CPS)报告他人(这也影响到家庭 消极的，最常发生在种族/少数民族群体中)。决策中的这种“双向”错误 对所有相关各方来说，这都是一笔高昂的成本。这些问题突显了以证据为基础的 骨折评估模型，用于在尝试区分虐待和虐待时为医疗决策提供信息 意外骨折。为了满足这一需求，我们开发并测试了骨折损伤可信性评估。 儿童长骨骨折模型(FxIPAM)治疗201例我们展示了它的区分能力 与虐待相关的骨折与意外创伤造成的骨折相比，也证明了它的理论 根据模型评分结果，有可能缩小虐待率评估中的种族/族裔差异。 在实施之前，需要进行验证。这项研究的目标是验证基于证据的模型 用于骨折评估，以提高临床医生区分滥用和意外骨折的能力 年幼的孩子。因此，在一项针对1000名儿童的前瞻性多中心研究中，我们提出了以下目标： 0-3岁，有长骨骨折：1)通过确定其预测性来验证我们的FxIPAM模型 准确区分滥用和意外的长骨骨折，以及2)估计 FxIPAM在跨种族/族裔的虐待评估和向CPS报告方面的假设应用 组。这项研究的成功将导致第一个用于幼儿骨折评估的有效模型。 FxIPAM的目的不是诊断虐待行为，而是作为一种筛查工具来识别处于危险中的儿童 对于需要进一步评估的虐待行为，并确定有合理伤害的儿童，在那里进一步工作 可以不要求滥用或向CPS报告。这种模式对公众健康的潜在影响是双向的： 减少了遗漏的虐待行为，减少了虐待行为评估和向CPS报告的差异。