An injury plausibility assessment model for differentiating abusive from accidental fractures in young children

区分幼儿虐待和意外骨折的伤害合理性评估模型

基本信息

批准号：
10033417
负责人：
GINA E. BERTOCCI
金额：
$ 72.48万
依托单位：
LURIE CHILDREN'S HOSPITAL OF CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-04 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10033417
关键词：
3 year old Abdominal Injuries Abuse Reporting Accidental Injury Accidents Address Age Biomechanics Biometry Bone Diseases Cessation of life Child Child Abuse Child Abuse and Neglect Childhood Consultations Dangerousness Data Set Decision Making Diagnosis Emergency Medicine Emergency department visit Environment Epidemic Ethnic Origin Ethnic group Evaluation Evaluation Reports Family Fracture Future Goals Hispanics Injury Investigation Lead Life Light Medical Minority Minority Groups Modeling Multicenter Studies Musculoskeletal Not Hispanic or Latino Observational Study Occult Fractures Orthopedic Surgery procedures Osteogenesis Imperfecta Outcome Outcome Measure Patients Performance Pilot Projects Provider Public Health Race Radiology Specialty Recording of previous events Reference Standards Reporting Research Personnel Rickets Risk Risk Factors Sampling Screening procedure Skeletal Survey Skin Social Work Specificity Testing Time Trauma Traumatic Brain Injury United States Validation Visit Work base bone health care seeking child physical abuse child protective service clinical decision-making cohort cost ethnic disparity ethnic minority population evidence base high risk improved long bone multidisciplinary physical abuse prospective psychosocial racial and ethnic disparities success

项目摘要

PROJECT SUMMARY / ABSTRACT Child abuse is a public health epidemic with devastating consequences for young children. In 2017, there were 676,000 victims of child abuse and neglect in the United States including approximately 1700 deaths. Young children are especially vulnerable - 81% of these deaths occurred among children 0-3 years old. Physical child abuse results in over 120,000 cases a year (less than a quarter of all abuse cases), but accounts for over half of the deaths, speaking to the heightened risk for a child. Fractures are the most common serious injury from physical abuse, occurring more often than abuse-related traumatic brain injury and abdominal injury combined. Each year in the United States there are more than 90,000 emergency department visits for fractures in children age 0-5 years (most often involving the long bones), with abuse-related fractures peaking in the first 3 years of life. It can be extremely difficult for providers to differentiate abuse-related fractures from those associated with an accident in these young children. This difficulty results in a bidirectional problem: under evaluation and missed abuse for some (which may result in re-injury or even death), and over evaluation for abuse and reporting to state child protective services (CPS) for others (which also impacts families negatively, and occurs most often in race/ethnic minority groups). Such “bidirectional” errors in decision making come at a high cost to all involved. These issues highlight the critical need for an evidence-based fracture assessment model to inform medical decision-making when attempting to differentiate abusive from accidental fractures. To address this need, we developed and tested a fracture injury plausibility assessment model (FxIPAM) in 201 children with long bone fractures. We demonstrated its capability to differentiate abuse-related fractures from those resulting from accidental trauma and also demonstrated its theoretical potential to decrease race/ethnic disparities in rates of abuse evaluations, based on model scoring results. Before implementation, validation is required. The goal of this study is to validate an evidence-based model for fracture assessments to improve the clinician’s ability to differentiate abuse from accidental fractures in young children. Therefore, we propose the following aims in a prospective multicenter study of 1000 children, 0-3 years of age, with a long bone fracture: 1) Validate our FxIPAM model by determining its predictive accuracy to differentiate between abuse vs. accidental long bone fractures, and 2) estimate the impact of a hypothetical application of the FxIPAM on abuse assessments and reporting to CPS across race/ethnic groups. Success of this study will result in the first validated model for fracture assessments in young children. The intent of the FxIPAM is not to diagnose abuse but to function as a screening tool to identify children at risk for abuse who require further evaluation and to identify children with plausible injuries where further work for abuse or reporting to CPS may not be require. The potential public health impact of this model is bidirectional: decreased missed abuse and decreased disparities in abuse evaluations and reporting to CPS.

项目摘要 /摘要虐待儿童是一种公共卫生流行病，对幼儿造成了毁灭性的后果。在2017年，有在美国，有676,000名虐待和忽视儿童的受害者包括大约1700人死亡。年轻的儿童特别容易受到伤害 - 这些死亡中有81％发生在0-3岁的儿童中。身体上的孩子滥用每年超过120,000例（少于所有虐待案件的四分之一），但占一半以上在死亡中，对儿童的风险更高。骨折是最常见的严重伤害由于身体虐待，发生的频率比与滥用相关的脑损伤和腹部损伤更频繁合并。每年在美国，有90,000多个紧急部门访问儿童骨折0-5岁（通常涉及长骨头），与滥用相关的骨折达到峰值在生命的头三年。对于提供者来说，将与滥用相关的裂缝与这些年幼的孩子的事故相关的人。这一困难导致双向问题：在评估和错过某些人的虐待下（可能导致重伤甚至死亡），并且过度评估虐待和向其他人报告的儿童保护服务（CPS）（这也影响家庭负面的，最常发生在种族/族裔少数群体中）。这样的“双向”决定错误使所有参与者的成本高昂。这些问题强调了基于证据的关键需求裂缝评估模型在试图区分滥用与意外断裂。为了满足这一需求，我们开发并测试了断裂损伤合理性评估 201个长骨骨折儿童的模型（FXIPAM）。我们证明了它分化的能力因偶然创伤而引起的滥用相关裂缝，也证明了其理论根据模型评分结果，有可能在滥用评估率中降低种族/种族差异。在实施之前，需要验证。这项研究的目的是验证基于证据的模型为了使骨折评估提高临床区分滥用与意外骨折的能力年幼的孩子。因此，我们提出了以下目标，以对1000名儿童进行预期的多中心研究 0-3岁，骨折长：1）通过确定其预测性来验证我们的FXIPAM模型准确区分虐待与意外长骨骨折的准确性，以及2）估计A的影响 FXIPAM在滥用评估中的假设应用和跨种族/种族向CPS报告组。这项研究的成功将导致第一个经过验证的幼儿断裂评估模型。 FXIPAM的目的不是诊断滥用对于需要进一步评估并确定可能受伤的儿童的虐待，在此进一步工作可能不需要滥用或向CPS报告。该模型的潜在公共卫生影响是双向的：滥用虐待和滥用评估和向CPS报告的差异减少。