Department of Pediatrics (D Zamalin), Kravis Children's Hospital, Icahn School of Medicine, Mount Sinai Hospital, New York, NY.
Perelman School of Medicine (I Hamlin), University of Pennsylvania, Philadelphia, Pa.
Acad Pediatr. 2024 Jan-Feb;24(1):78-86. doi: 10.1016/j.acap.2023.05.002. Epub 2023 May 11.
Suspicion for child abuse is influenced by implicit biases. Evaluation by a Child Abuse Pediatrician (CAP) may reduce avoidable child protective services (CPS) referrals. Our objective was to investigate the association of patient demographic, social and clinical characteristics with CPS referral before consultation by a CAP (preconsultation referral).
Children<5years-old undergoing in-person CAP consultation for suspected physical abuse from February 2021 through April 2022 were identified in CAPNET, a multicenter child abuse research network. Marginal standardization implemented with logistic regression analysis examined hospital-level variation and identified demographic, social, and clinical factors associated with preconsultation referral adjusting for CAP's final assessment of abuse likelihood.
Among the 61% (1005/1657) of cases with preconsultation referral, the CAP consultant had low concern for abuse in 38% (384/1005). Preconsultation referrals ranged from 25% to 78% of cases across 10 hospitals (P < .001). In multivariable analyses, preconsultation referral was associated with public insurance, caregiver history of CPS involvement, history of intimate partner violence, higher CAP level of concern for abuse, hospital transfer, and near-fatality (all P < .05). The difference in preconsultation referral prevalence for children with public versus private insurance was significant for children with low CAP concern for abuse (52% vs 38%) but not those with higher concern for abuse (73% vs 73%), (P = .023 for interaction of insurance and abuse likelihood category). There were no differences in preconsultation referral based on race or ethnicity.
Biases based on socioeconomic status and social factors may impact decisions to refer to CPS before CAP consultation.
儿童虐待的怀疑受到内隐偏见的影响。由儿童虐待专科医生 (CAP) 进行评估可能会减少不必要的儿童保护服务 (CPS) 转介。我们的目的是调查在 CAP 咨询前（咨询前转介），患者人口统计学、社会和临床特征与 CPS 转介之间的关联。
从 2021 年 2 月至 2022 年 4 月，通过多中心儿童虐待研究网络 CAPNET，确定了因疑似身体虐待而接受 CAP 当面咨询的<5 岁儿童。使用逻辑回归分析实施边缘标准化，检查医院层面的差异，并确定与咨询前转介相关的人口统计学、社会和临床因素，同时调整 CAP 对虐待可能性的最终评估。
在 61%（1005/1657）有咨询前转介的病例中，CAP 顾问对 38%（384/1005）的病例的虐待关注度较低。在 10 家医院中，咨询前转介的比例在 25%至 78%之间（P<.001）。在多变量分析中，咨询前转介与公共保险、照顾者有 CPS 参与史、亲密伴侣暴力史、CAP 对虐待关注度更高、医院转院和接近死亡（均 P<.05）相关。对于 CAP 对虐待关注度较低的儿童，公共保险与私人保险之间咨询前转介的发生率差异显著（52%与 38%），但对于 CAP 对虐待关注度较高的儿童，差异不显著（73%与 73%），（保险和虐待可能性类别之间的交互作用 P=.023）。种族或民族对咨询前转介没有影响。
基于社会经济地位和社会因素的偏见可能会影响 CAP 咨询前向 CPS 转介的决策。
