Expert Panels Improve ED Identification of Child Abuse vs. Accidents

April 25th, 2018

To ensure that physicians don’t make false accusations of child abuse, some pediatric emergency departments (EDs) depend on a panel of pediatric injury experts to make the call on whether an injury is an accident or intentional harm.

The question remains: How accurate are those types of panels?

A study published recently in the Journal of Pediatrics looks at how successful a nine-member panel was in determining the likelihood of abuse in more than 2,000 cases.

University of Louisville-led researchers report that their study found almost perfect reliability and accuracy with members of the panel—both individually and as a whole.

“Decision rules for identifying injuries from abuse are valuable for settings such as pediatric emergency departments—in these cases, reliability and accuracy of human judgement is needed since victims of child abuse are at high risk of future abuse and death," explained lead author Doug Lorenz, PhD, a biostatistician and associate professor at the School of Public Health and Information Sciences.

The focus of the study was bruising injuries involving children younger than 4 years old who visited pediatric EDs between 2011 and 2016 at five children's hospitals in the United States. On the expert panel were four child abuse specialist pediatricians, four emergency medicine physicians, and one bioengineer with expertise in pediatric injury.

Panelists were provided deidentified case information on 2,166 children, including current and past data of visits to a pediatric ED, and asked to independently rate the likelihood of abuse on a 5-level classification scale as “definite abuse,” “likely abuse,” “indeterminate,” “likely accident,” and “definite accident.” Each panelist also answered a question on whether the case should be reported to state child protective services.

“A panel of experts with different backgrounds but common expertise in pediatric injury is a reliable and accurate criterion standard for classifying pediatric injuries as abusive or accidental in a sample of children presenting to a pediatric emergency department,” study authors concluded.