Some childhood injuries are easily recognized as being caused by abuse, while others are not so clear cut. Yet primary care physicians (PCPs) suspect that 21 percent of the childhood injuries they evaluate are caused by abuse, according to a recent study supported by the Agency for Healthcare Research and Quality (HS09811).
Emalee Gottbrath Flaherty, M.D., of Northwestern University Medical School, and her colleagues examined data from 12,510 primary care office visits during a 1-month period. The PCPs evaluated 659 injuries. The Chicago-area urban and suburban PCPs described the injury type, reported causes and severity, and documented their assessment of the cause of injury. They also determined their level of suspicion that the injury was caused by abuse on a 5-point scale, with 1 being impossible and 5 being virtually certain.
The PCPs had "some suspicion" of abuse for 21 percent of injuries. Injuries not compatible with the child's medical history and parental delays in seeking medical care for the injury were red flags that raised doctors' suspicions of abuse. Suspicion of abuse was also more likely to be associated with higher injury severity, age less than 6 or 7 years, Medicaid or self-pay health care, family risk factors for abuse (such as domestic violence and substance abuse), and more recent physician education about child abuse.
PCPs also were more likely to suspect abuse of children who were Hispanic or black (vs. white) and for children whose mothers had less than a college education. PCPs said they had reported most, but not all, cases of suspected child abuse. They cited past negative experiences with child protection service (CPS) agencies and perceived lack of benefit for the child as reasons for not reporting abuse. However, recent education about child abuse increased the probability that they would report all suspected abuse. One study limitation was that data were collected from relatively few doctors from one geographic area and just one State CPS system.
More details are in "Assessment of suspicion of abuse in the primary care setting," by Dr. Flaherty, Robert Sege, M.D., Ph.D., Christine L. Mattson, B.S. and others, in the March 2002 Ambulatory Pediatrics 2(2), pp. 120-126.