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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

基本信息

批准号：
10033417
负责人：
GINA E. BERTOCCI
金额：
$ 72.48万
依托单位：
LURIE CHILDREN'S HOSPITAL OF CHICAGO
依托单位国家：
美国
项目类别：
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/10033417
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 Hispanics Injury Investigation Lead Life Light Medical Minority Minority Groups Modeling Multicenter Studies Musculoskeletal Not Hispanic or Latino Observational Study Occult Fractures Orthopedic Surgery procedures 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

项目摘要

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