Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts 02118, USA.
Acad Pediatr. 2011 Nov-Dec;11(6):460-6. doi: 10.1016/j.acap.2011.08.005. Epub 2011 Oct 12.
This study examined the validity of primary health care providers' (PHCPs) assessment of suspicion that an injury was caused by child abuse and their decision to report suspected child abuse to child protective services (CPS).
By using a subsample of injuries drawn from the 15,003 childhood injuries evaluated in the Child Abuse Recognition and Evaluation Study, PHCPs completed telephone interviews concerning a stratified sample (no suspicion of abuse; suspicious but not reported; and suspicious of abuse and reported) of 111 injury visits. Two techniques were used to validate the PHCPs' initial decision: expert review and provider retrospective self-assessment. Five child abuse experts reviewed clinical vignettes created by using data prospectively collected by PHCPs about the patient encounter. The PHCPs' opinions 6 weeks and 6 months after the injury-related visits were elicited and analyzed.
PHCPs and experts agreed about the suspicion of abuse in 81% of the cases of physical injury. PHCPs did not report 21% of injuries that experts would have reported. Compared with expert reviewers, PHCPs had a 68% sensitivity and 96% specificity in reporting child abuse. A PHCP's decision to report suspected child abuse to CPS did not reduce the frequency of primary care follow-up in the 6 months after the index visit. PCHPs received information from their state CPS in 70% of the reported cases.
Child abuse experts and PHCPs are in general agreement concerning the assessment of suspected child physical abuse, although experts would have reported suspected abuse to CPS more frequently than the PHCPs. Future training should focus on clear guidance for better recognition of injuries that are suspicious for child abuse and state laws that mandate reporting.
本研究检验了初级保健提供者（PHCPs）对疑似虐待儿童的伤害的评估的有效性，以及他们向儿童保护服务（CPS）报告疑似虐待儿童的决定。
通过使用儿童虐待识别和评估研究中评估的 15003 例儿童伤害中的一个子样本，PHCPs 完成了关于受伤就诊的分层样本（无虐待怀疑；可疑但未报告；可疑且报告）的电话访谈。使用两种技术来验证 PHCPs 的初始决定：专家审查和提供者回顾性自我评估。五位儿童虐待专家审查了由 PHCPs 前瞻性收集的关于患者就诊的数据创建的临床病例。在受伤相关就诊后 6 周和 6 个月，引出并分析了 PHCPs 的意见。
PHCPs 和专家在 81%的身体伤害案例中对虐待怀疑达成一致。PHCPs 没有报告专家会报告的 21%的伤害。与专家审查者相比，PHCPs 在报告儿童虐待方面的敏感性为 68%，特异性为 96%。PHCP 向 CPS 报告疑似虐待儿童的决定并未减少指数就诊后 6 个月内的初级保健随访频率。PHCPs 在 70%的报告案例中收到了来自其所在州 CPS 的信息。
儿童虐待专家和 PHCPs 通常在疑似儿童身体虐待的评估方面达成一致，尽管专家会比 PHCPs 更频繁地向 CPS 报告疑似虐待。未来的培训应侧重于明确指导，以更好地识别可疑的虐待儿童伤害，并制定强制报告的州法律。
