Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
J Pediatr. 2012 Jun;160(6):1003-8.e1. doi: 10.1016/j.jpeds.2011.11.042. Epub 2012 Jan 4.
To measure empirically the influence of race and socioeconomic status (SES) on the diagnosis of child abuse and willingness to report to child protection services.
A total of 5000 pediatricians randomly selected from the American Medical Association's Masterfile received 1 of 4 randomly assigned versions of a fictional clinical presentation of a child (black/white + high SES/low SES) that described an unwitnessed event in a mobile 18-month-old child resulting in an oblique femur fracture. Outcome measures included ranking the degree to which the injury was accidental versus abuse and agreement with reporting the injury to child protection services.
A total of 2109 of 4423 physicians responded (47.7%). Patient's race did not have an effect on a diagnosis of abuse (black, 45% versus white, 46%). Abuse was more likely to be diagnosed in patients with low SES (48% versus 43%, overall P = .02).
This study supports earlier work demonstrating physicians' greater willingness to consider abuse as a potential cause of injury in low SES children. It failed to demonstrate the finding of retrospective, real world studies of an increased likelihood to consider abuse in black patients. Future work should try to understand why there remains a differential approach to evaluating minority children for abuse in real world settings.
通过实证研究，衡量种族和社会经济地位（SES）对儿童虐待诊断的影响，以及向儿童保护服务机构报告的意愿。
从美国医学协会的 Masterfile 中随机抽取的 5000 名儿科医生，收到了 4 种随机分配的虚构临床病例的其中 1 种，这些病例描述了一个移动的 18 个月大的孩子身上未被目击的事件，导致股骨斜形骨折。主要观察指标包括对损伤是意外还是虐待的程度进行排序，并对向儿童保护服务机构报告损伤的意愿进行评估。
共有 4423 名医生中的 2109 名（47.7%）做出了回应。患者的种族对虐待的诊断没有影响（黑人，45%；白人，46%）。SES 较低的患者更有可能被诊断为虐待（48%对 43%，总体 P =.02）。
本研究支持了早期的工作，即表明医生更愿意将 SES 较低的儿童的损伤视为虐待的潜在原因。它未能证明在黑人患者中更有可能考虑虐待的回顾性、真实世界研究的发现。未来的研究应努力了解为什么在真实环境中，对少数族裔儿童进行虐待评估的方法仍然存在差异。
