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: 10254257
• 负责人: GINA E. BERTOCCI
• 金额: $ 68.7万
• 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/10254257
• 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; 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.

项目总结/摘要 虐待儿童是一种公共卫生流行病，对幼儿造成毁灭性后果。2017年 在美国，有676，000名儿童遭受虐待和忽视，其中约1700人死亡。年轻 儿童尤其脆弱- 81%的死亡发生在0-3岁的儿童中。实体下代 虐待导致每年超过12万起案件（不到所有虐待案件的四分之一），但占一半以上 死亡人数的增加，这说明了儿童的高风险。骨折是最常见的严重损伤 身体虐待，发生率高于与虐待有关的创伤性脑损伤和腹部损伤 加起来在美国，每年有超过90，000次急诊就诊， 0-5岁儿童骨折（最常累及长骨），与滥用相关的骨折最多 在生命的前三年。对于提供者来说，区分与滥用有关的骨折和 与这些孩子的事故有关的。这种困难导致了一个双向问题： 评估不足，一些人错过了滥用（这可能导致再次受伤甚至死亡），以及过度评估 虐待和报告国家儿童保护服务（CPS）为他人（这也影响家庭 消极的，最常发生在种族/少数民族群体中）。这种“双向”决策错误 让所有参与者付出高昂的代价。这些问题突出表明，迫切需要一个基于证据的 骨折评估模型，以告知医疗决策时，试图区分虐待， 意外骨折为了满足这一需求，我们开发并测试了一种骨折损伤可扩展性评估方法， 模型（FxIPAM）在201例儿童长骨骨折中的应用。我们证明了它的能力， 虐待相关的骨折，从那些造成意外创伤，也证明了其理论 根据模型评分结果，有可能减少虐待评价率中的种族/族裔差异。 在实施之前，需要进行验证。本研究的目的是验证一个基于证据的模型 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，我们在一项1000名儿童的前瞻性多中心研究中提出了以下目标， 0-3岁，长骨骨折：1）通过确定其预测性来验证我们的FxIPAM模型 区分滥用与意外长骨骨折的准确性，以及2）估计 FxIPAM在跨种族/族裔滥用评估和向CPS报告方面的假设应用 组这项研究的成功将导致第一个有效的模型，用于评估幼儿骨折。 FxIPAM的目的不是诊断虐待，而是作为一种筛查工具，以识别有风险的儿童 虐待谁需要进一步评估，并确定儿童与合理的伤害，进一步的工作， 滥用或向CPS报告可能不需要。这种模式的潜在公共卫生影响是双向的： 减少遗漏的虐待，减少虐待评估和向CPS报告的差异。