Lane Wendy G, Dubowitz Howard
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Clin Orthop Relat Res. 2007 Aug;461:219-25. doi: 10.1097/BLO.0b013e31805c0849.
Child abuse is a serious problem in the United States. Because orthopaedic surgeons are responsible for identifying and reporting suspicious fractures to child protective services, we asked two primary questions: (1) How skilled are orthopaedists in distinguishing abuse-related from noninflicted fractures and making appropriate child protective services reports?; and (2) Are decisions influenced by orthopaedist training or by the race or socioeconomic status of injured children? We developed and mailed a questionnaire containing 10 case vignettes to 974 US orthopaedists. Respondents assessed the likelihood of abuse and need to report to child protective services. Two versions of the questionnaire differed by the race and socioeconomic status of vignette families. Average respondent scores were 79% for correct diagnoses and 73% for correct reporting decisions. Pediatric orthopaedists had higher adjusted scores for identifying abuse-related versus noninflicted injuries (82% versus 73%) and for appropriately reporting to child protective services (76% versus 66%) compared with general orthopaedists. Both groups had difficulty distinguishing abuse-related from noninflicted long-bone fractures in infants and toddlers. We found no differences in appropriate identification or reporting of fractures by race but did find differences by social class. Additional training in identifying abuse-related long-bone fractures appears necessary. Orthopaedists should consider the potential for bias when assessing children with fractures for possible abuse.
在美国，虐待儿童是一个严重的问题。由于整形外科医生负责识别可疑骨折并向儿童保护服务机构报告，我们提出了两个主要问题：（1）整形外科医生在区分与虐待相关的骨折和非受虐骨折以及做出适当的儿童保护服务报告方面有多熟练？（2）这些决定是否受到整形外科医生培训的影响，或者受到受伤儿童的种族或社会经济地位的影响？我们编制并向974名美国整形外科医生邮寄了一份包含10个病例 vignette 的问卷。受访者评估了虐待的可能性以及向儿童保护服务机构报告的必要性。问卷的两个版本在 vignette 家庭的种族和社会经济地位方面有所不同。受访者的平均正确诊断得分是79%，正确报告决定得分是73%。与普通整形外科医生相比，小儿整形外科医生在识别与虐待相关的损伤与非受虐损伤方面（82%对73%）以及向儿童保护服务机构适当报告方面（76%对66%）的调整得分更高。两组在区分婴儿和幼儿中与虐待相关的骨折和非受虐的长骨骨折方面都有困难。我们发现，在骨折的适当识别或报告方面，种族没有差异，但社会阶层存在差异。似乎有必要对识别与虐待相关的长骨骨折进行额外培训。整形外科医生在评估可能遭受虐待的骨折儿童时应考虑到存在偏见的可能性。
