The Use of Experts to Evaluate a Child Abuse Guideline in Community Emergency Departments
Abstract
OBJECTIVES
Guidelines and pathways exist to help frontline providers evaluate injured children for suspected child abuse. Little, however, is known about whether the decision-making resulting from these interventions is correct. Therefore, in the absence of an available gold-standard test, we used experts' judgments to examine the appropriateness of these clinical decisions. We evaluated community emergency department (ED) providers' adherence to a guideline recommending a child protection team (CPT) consultation for infants with injuries associated with abuse. We then compared providers' decision-making to experts' recommendations before and after guideline implementation.
METHODS
Two experts conducted a blinded, retrospective review of injured infants from three community EDs (N = 175). Experts rated the likelihood that an injury was abusive, indeterminate, or accidental, and made recommendations that were compared with skeletal survey (SS) testing and child protective services (CPS) reporting by providers before and after guideline implementation.
RESULTS
Post-guideline implementation, there was a significant increase in CPT consultations in indeterminate cases (14.3% vs. 72.2%, p < .001) and in SS testing when experts recommended SS (20.6% vs. 56.8%, p = .002). In contrast, a higher percentage of cases for whom the experts did not recommend reporting were reported to CPS (1.8% vs 14.6%, p = .02).
CONCLUSIONS
Providers consulted the CPT most often for indeterminate cases.…
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