Improving the Quality of Care for Abused and Neglected Children
Child abuse research at CPCE focuses on improving quality of care delivered in the medical and child welfare systems to suspected victims of child maltreatment.
In 2011, 1 in 8 US children had a confirmed case of abuse or neglect, with the highest rates among young children. Hospitals have unique opportunities to detect child abuse through screening tools, such as a skeletal survey which reveals occult fractures. In fact, the American Academy of Pediatrics asserts that skeletal surveys be performed in all children under 2 years old suspected of being victims of physical abuse; yet, many hospitals fail to utilize these tools appropriately.
The aim for this line of CPCE research, led by Joanne Wood, MD, MSHP, is to improve occult injury screening practices for young children suspected of being victims of physical abuse.
An evaluation of the performance of occult injury screenings in hospitals across the US, using databases such as Premier Perspective and Pediatric Hospitals Information System (PHIS), found great variation in occult injury screening practices across US hospitals. At 366 hospitals evaluated (12 of which were pediatric), only 48 percent of children under 2 years old suspected of being victims of abuse were screened for occult injuries, with adjusted rates ranging from 15 percent to 100 percent.
At 40 pediatric hospitals in PHIS, the results were more promising: 83 percent of children under age 2 years suspected of being victims of abuse were screened for occult fractures, with adjusted rates ranging from 55 percent to 93 percent.
The researchers are now using the RAND/UCLA Appropriateness Method, which synthesizes the scientific literature and expert opinion for how best to implement science in the real world, to develop guidelines for clinicians on appropriate use of skeletal surveys.
Clinical guidelines for use of skeletal surveys in children under age 2 years presenting with fractures or bruises have been developed. These guidelines are being validated in a multi-center retrospective study. Also underway: guidelines for children under age 2 years presenting with traumatic brain injury.
What’s Next: In the next phase of research, we plan to evaluate the sensitivity of occult injury screening tools in identifying actual physical abuse in children.
Funding: National Institute of Health’s National Institute of Child Health and Human Development
Please contact Joanne Wood, MD, MSHP, CHOP attending physician and Child Abuse Pediatrics research director, Safe Place, for more information about this line of research.
Wood JN, Fakeye O, Mondestin V, Rubin DM, Localio, R, Feutner C. Development of Hospital-Based Guidelines for Skeletal Survey in Young Children with Bruises. Pediatrics, 2015. 132(2):312-320.
Wood JN, Fakeye O, Mondestin V, Rubin DM, Localio R, Feudtner C. Prevalence of abuse among young children with femur fractures: a systematic review. BMC Pediatrics, 2014. 14(1):169.
Wood JN, Fakeye O, Feudtner C, Mondestin V, Localio R, Rubin DM. Development of Guidelines for Skeletal Survey in Young Children With Fractures. Pediatrics, 2014; 134(1):45-53.
Wade R, Shea JA, Rubin D, Wood JN. Adverse Childhood Experiences of Low-Income Urban Youth. Pediatrics, 2014. 134(1):13-20.
Frioux S, Wood JN, Fakeye O, Luan X, Localio R, Rubin DM. Longitudinal Association of Country-Level Economic Indicators and Child Maltreatment Incidents. Maternal and Child Health Journal, 2014; 18(9): 2202-2208.
McKeag H, Christian CW, Rubin DM, Daymont C Pollock AN, Wood JN. Subdural hemorrhage in pediatric patients with an enlargement of the subarachnoid spaces. Journal of Neurosurgery Pediatrics, 2013. 11:438-444.
Putnam-Hornstein E, Wood JN, Fluke JD, Yoshioka-Maxwell A, Berger RP. Preventing severe and fatal child maltreatment: making the case for the expanded use and integration of data. Child Welfare, 2013. 92(2):59-75.
Wood JN, Feudtner C, Medina SP, Luan X, Localio R, Rubin DM. Variation in Occult Injury Screening for Children with Suspected Abuse in Selected US Children’s Hospitals. Pediatrics, 2012. 130(5): 853-860.
Carroll R, Wood JN. Sudden Unexpected Infant Death: A Compassionate Forensic Approach to Care. Clinical Pediatric Emergency Medicine, 2012. 13(3): 239-248.
Wood JN, Medina SP, Feudtner C, Luan X, Localio R, Fieldston ES, Rubin DM. Local Macroeconomic Trends and Hospital Admissions for Child Abuse, 2000-2009. Pediatrics, 2012. 130(2): e358-64.
Wood JN, Pecker LH, Russo ME, Henretig F, Christian CW. Evaluation and referral for child maltreatment in pediatric poisoning victims. Child Abuse & Neglect, 2012. 36(4): 362-329.
Ibrahim NG, Wood JN, Margulies SS, Christian CW. Influence of age and fall type on head injuries in infants and toddlers. International Journal of Developmental Neuroscience, 2011. 30(3): 201-206.
Schilling S, Wood JN, Levine MA, Langdon D, Christian CW. Vitamin D Status in Abused and Nonabused Children Younger than 2 Years Old with Fractures. Pediatrics, 2011. 127(5): 835-841.
Wood JN, Hall M, Schilling S, Keren R, Mitra N, Rubin DM. Disparities in the Evaluation and Diagnosis of Abuse Among Infants with Traumatic Brain Injury. Pediatrics, 2010. 126(3): 408-414.
Wood JN, Christian CW, Adams CM, Rubin DM. Skeletal Surveys in Infants With Isolated Skull Fractures. Pediatrics, 2009. 123(2): e247-252.
Wood JN, Rubin DM, Nance ML, Christian CW. Distinguishing inflicted versus accidental abdominal injuries in young children. The Journal of Trauma, 2005. 59(5): 1203-1208.