Perceptions of Social Risk in Medical Child Abuse Evaluation

描述（由申请人提供）：我们的长期目标是减少虐待儿童专家对受伤儿童的评估和诊断的可变性。儿童损伤评估和诊断的差异可能是由于许多原因造成的，包括对损伤生物力学的不完全理解和缺乏金标准诊断测试。这个项目集中在医生的偏见是否是评估和诊断儿童虐待伤害的可变性的来源。如果儿童的社会历史导致医生预期伤害是虐待性的或不是虐待性的，这种“期望偏差”可能会影响儿童随后的评估或诊断。本研究的具体目的是：(1)确定儿童社会历史的哪些组成部分影响检查医生对虐待风险的感知；(2)确定儿童的评估或诊断是否因医生的风险认知而改变；(3)建立三种共识评价，作为医师评价的比较。医生将使用基于网络的模板提交和审查三种损伤类型（创伤性脑损伤、长骨骨折和颅骨骨折）的病例。医生将评估他们对每个伤害案例的社会风险感知。检查医师提交的病例文本将使用定性分析技术进行分析，以确定先验定义的社会风险因素和新定义的社会线索。社会线索是医生对家庭和儿童社会环境的印象，包括在评估文本中，可以更全面地了解儿童的环境。定量分析，使用线性混合效应模型，将用于检查哪些因素编码在儿童的情况评估有助于医生的感知虐待伤害的风险。在“特定目标2”中，医生们相互审查提交的病例。第一审稿人将阅读完整的书面报告。第二审稿人将阅读一份经过调查人员修改的报告，以排除积极或消极的偏见语言、社会历史和社会线索。评估将根据是否符合具体目标3中制定的共识评估来评分。将对评估结果进行比较，以确定掌握不同家庭社会信息的医生对儿童的评价是否不同。将使用使用logit-link函数的广义估计方程。同样，诊断的比较将根据医生的角色（审查员与审查员）和风险感知评分进行。最后，每个损伤类别的共识评估将由参与的医生使用互联网辅助德尔菲过程开发。最后提出共识评价，是为了避免影响审查员的评价。这些分析的目的是了解是什么导致了风险感知，并发现偏见是否在医生的行为中起作用。

DESCRIPTION (provided by applicant): Our long-term objective is to decrease the variability in evaluations and diagnoses of injured children by child abuse specialists. Variation in the evaluation and diagnosis of childhood injuries may be due to many sources including an incomplete understanding of the biomechanics of injuries and a lack of gold standard diagnostic tests. This project concentrates on whether physician bias is a source of variability in evaluations and diagnoses of childhood injuries for abuse. If the child's social history causes the physician to expect an injury was abusive or not abusive, this "expectation bias" may influence the child's subsequent evaluation or diagnosis. The specific aims of this study are (1) to determine what components of the child's social history influence the examining physician's perception of risk for abuse; (2) to determine if the child's evaluation or diagnosis is changed by the physician's risk perception; and (3) to create three consensus evaluations to act as comparators to the physician's evaluations. Physicians will both submit and review cases of three injury types (traumatic brain injury, long-bone fracture, and skull fracture) using a web-based template. Physicians will rate their perceptions of social risk for each injury case. The texts of the cases submitted by the examining physician will be analyzed using qualitative analysis techniques to identify a priori defined social risk factors and de novo defined social cues. Social cues are physicians' impressions of the family and the child's social setting included in the text of the evaluation that give a more complete picture of the child's environment. Quantitative analysis, using linear mixed effects models, will be used to examine which elements encoded in the child's case evaluation contribute to the physician's perception of risk for an abusive injury. For Specific Aim 2, physicians review each others' submitted cases. The first reviewer will read the full written report. The second reviewer will read a report altered by the investigators to exclude positive or negative prejudicial language, social history, and social cues. Evaluations will be scored by whether they met or did not meet the consensus evaluation developed in Specific Aim 3. Evaluations will be compared to determine whether physicians with different amounts of social information about the family evaluate children differently. Generalized estimating equations using the logit-link function will be used. Likewise, comparisons of diagnoses will be made by physician role (examiner versus reviewer) and by risk perception score. Finally, the consensus evaluation for each injury category will be developed by the participating physicians using an internet assisted Delphi process. The consensus evaluation is developed last in order to avoid influencing examiners' evaluations. These analyses are designed to understand what contributes to risk perception and to find if bias plays a role in physician behavior.