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儿童虐待专家对受伤儿童的评估和诊断的变化。儿童损伤的评估和诊断的差异可能是由于许多来源，包括对损伤的生物力学的不完全理解和缺乏金标准诊断测试。该项目集中在医生的偏见是否是一个来源的变异性的评估和诊断儿童伤害的虐待。如果儿童的社会历史导致医生预期伤害是虐待或非虐待，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感知而改变;（3）创建三个共识评估，作为医生评估的比较。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的看法。将使用定性分析技术对检查医生提交的病例文本进行分析，以确定先验定义的社会风险因素和从头定义的社会线索。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，提供了儿童环境的更完整的画面。定量分析，使用线性混合效应模型，将被用来检查哪些元素编码在儿童的情况下的评估有助于医生的感知风险的虐待性伤害。对于具体目标2，医生审查彼此提交的病例。第一位评审员将阅读完整的书面报告。第二位审查员将阅读一份由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。评价将根据是否符合具体目标3中制定的共识评价进行评分。评估将进行比较，以确定是否医生与不同数量的社会信息的家庭评估儿童不同。将使用使用logit-link函数的广义估计方程。同样，将根据医生角色（检查者与审查者）和风险感知评分进行诊断比较。最后，将由参与医生使用互联网辅助的德尔菲过程对每个损伤类别进行共识评估。为了避免影响考官的评价，最后发展了一致性评价。这些分析的目的是了解什么有助于风险感知，并发现偏见是否在医生行为中发挥作用。 公共卫生相关性：每年发现90万儿童遭受虐待或忽视。正确诊断儿童伤害是虐待还是非虐待是很重要的：不正确的诊断可能导致儿童被不适当地从家中带走或留下遭受进一步的虐待。这个项目将讨论医生的偏见是否影响身体虐待儿童的评估或诊断。

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. PUBLIC HEALTH RELEVANCE: Each year 900,000 children are found to have suffered abuse or neglect. Correct diagnosis of childhood injuries as abusive or not abusive is important: incorrect diagnosis could lead to a child being improperly taken from his home or left to suffer further abuse. This project will address whether physician bias influences the evaluation or diagnosis of physical child abuse.