Variation in Use of Neuroimaging in the Care of Infants Undergoing Subspecialty Evaluations for Abuse: A Multicenter Study.

Objectives: 1) To quantify hospital-level variation in use of neuroimaging to screen for intracranial injury (ICI) among infants without overt signs or symptoms of head trauma undergoing subspecialty evaluations for physical abuse; 2) to assess for disproportionality in neuroimaging based on race and ethnicity and insurance type.

Methods: This was a cross-sectional study of infants age <12 months receiving subspecialty child abuse evaluations from February 2021 to December 2022 at 10 sites in CAPNET, a multicenter child abuse research network. Infants were included if they underwent a skeletal survey and lacked overt signs of possible ICI or blunt head injury.

Yield of skeletal surveys in national network of child abuse pediatricians: Age is key.

Background: Skeletal surveys (SS) are recommended for the evaluation of suspected physical abuse in children <2 years old. No guidelines exist for SS completion in children between 2 and 5 years old.

Objective: To determine rates of SS completion by age and examine variables associated with occult fracture identification in older children.

Practice Analysis: Developing a Content Outline for the Child Abuse Pediatrics Certification Exam.

The examination by which physicians achieve board certification in CAP should reflect the knowledge and skills required of the modern practitioner. The American Board of Pediatrics (ABP) assembled a 12-member volunteer panel of practicing child abuse pediatricians to conduct a practice analysis. In the first phase of the project, the panel identified and documented the practice domains, tasks, knowledge, and skills required for clinical practice.

Predictors of Making a Referral to Child Protective Services Prior to Expert Consultation.

Objective: Suspicion for child abuse is influenced by implicit biases. Evaluation by a Child Abuse Pediatrician (CAP) may reduce avoidable child protective services (CPS) referrals. Our objective was to investigate the association of patient demographic, social and clinical characteristics with CPS referral before consultation by a CAP (preconsultation referral).

Emerging Trends in Smartphone Photo Documentation of Child Physical Abuse.

Photo documentation of injuries on children is universally recommended in cases of suspected child physical abuse. As technology improves, the ability to document physical examination findings through smartphone photography is increasingly accessible and practical. The quality of images captured on smartphones now rivals traditional photography and the integration of photo capture within the electronic medical record has led to a variety of fields adopting smartphone photo documentation for diagnosis, consult, and follow-up.

Child Abuse Pediatrics Research Network: The CAPNET Core Data Project.

Objective: Examine the epidemiology of subspecialty physical abuse evaluations within CAPNET, a multicenter child abuse pediatrics research network.

Methods: We conducted a cross-sectional study of children <10 years old who underwent an evaluation (in-person or remote) by a child abuse pediatrician (CAP) due to concerns for physical abuse at ten CAPNET hospital systems from February 2021 through December 2021.

Results: Among 3667 patients with 3721 encounters, 69.

The CAPNET multi-center data set for child physical abuse: Rationale, methods and scope.

Background: The pediatric subspecialty of Child Abuse Pediatrics (CAP) was certified by the American Board of Medical Subspecialties in 2006. Relative to its impact on pediatric health, CAP-focused research has been relatively under-funded. Multi-center networks related to CAP-focused research have made important advances, but have been limited in scope and duration.

Improving Physical Abuse Documentation and Photography through a Remote Peer Review Intervention.

Unlabelled: Child Abuse Pediatrics is a small and geographically dispersed specialty. This article reports on an intervention to improve written and photodocumentation quality and uniformity in suspected child physical abuse cases, using a remote, de-identified case review system.

Methods: In each cycle, participants submitted de-identified medical reports and photographs for review by a child abuse pediatrics expert.

A Novel Scale to Communicate Perceived Likelihood of Child Sexual Abuse.

Background And Objective: Child abuse pediatricians (CAPs) are often asked to determine the likelihood that a particular child has been sexually abused. These determinations affect medical and legal interventions, and are important for multisite research. No widely accepted scale is available to communicate perceived sexual abuse likelihood.

Use of Imaging in Children With Witnessed Physical Abuse.

Objective: Physicians are occasionally asked to evaluate children who are reported to have been victims of witnessed abuse, but who have no injuries noted on examination. The rate of injury in these patients is presently unknown. This is important because abuse allegations are brought for both altruistic and other reasons.

Genital and Extragenital Gonorrhea and Chlamydia in Children and Adolescents Evaluated for Sexual Abuse.

Objective: The aim of this study was to describe the use of a nucleic acid amplification test in detecting genital and extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in children and adolescents assessed for sexual abuse/assault.

Methods: The charts of children aged 0 to 17 years, consecutively evaluated for sexual victimization, in emergency department and outpatient settings were reviewed. Data extracted included age, sex, type of sexual contact, anogenital findings, previous sexual contact, toxicology results, and sites tested for NG and CT.

Legal issues in child maltreatment.

The most common medicolegal issues include reporting child maltreatment, the presentation of ethical and effective expert testimony, informed consent in child maltreatment cases, and various liability risks related to child maltreatment cases. The health care professional who remains knowledgeable about the laws within their jurisdiction, the mandates of their professional society and state medical board, and the local resources (eg, child abuse pediatrician and hospital counsel) available to them minimizes medicolegal risk.

Assessment for self-blame and trauma symptoms during the medical evaluation of suspected sexual abuse.

The purpose of this study was to describe behavioural and emotional symptoms and to examine the effect of abuse-related factors, family responses to disclosure, and child self-blame on these symptoms in children presenting for medical evaluations after disclosure of sexual abuse. A retrospective review was conducted of 501 children ages 8-17. Trauma symptoms were determined by two sets of qualitative measures.

The effect of image quality on the assessment of child abuse photographs.

Objectives: Although child abuse pediatricians are frequently asked to evaluate risk of abuse based on photographs, the effect of photographic quality on this process is presently unknown. Photographs of abused children are often taken by professionals without photographic training, and quality varies widely. This article reports the first study of the effect of image quality on clinical assessment from photographs.

First rib fractures in abused infants: a report of three cases.

The authors describe 4 first rib fractures in 3 infants, highlighting the difficulty in detecting first rib fractures on skeletal survey. All 4 fractures were the result of physical abuse. A literature search does not find a case of first rib fracture in a healthy infant that is not the result of child abuse.

Nonpharmacological harm-reduction interventions in British substance-misuse services.

The present study was designed to assess the acceptability and availability of harm-reduction interventions, including needle exchange, education regarding safer drug-ingestion methods, complementary/alternative therapies, and safe places where problem drinkers and drug takers may stay after consumption or may consume substances on the premises. We surveyed a nationwide sample of agencies listed in directories of substance-abuse services in England, Wales, and Scotland. Seventy percent (436 of 623 eligible agencies) returned questionnaires.

Acceptability and availability of pharmacological interventions for substance misuse by British NHS treatment services.

Aims: Despite their potential advantages, many of the pharmacological interventions available to treat substance misuse are controversial and their acceptability within the United Kingdom (and other countries) has only recently begun to be investigated.

Design: A questionnaire mailed to British National Health Service (NHS) alcohol and drug treatment services asked respondents to rate the acceptability and availability of 11 pharmacological interventions for substance misuse employed to relieve withdrawal, reduce the likelihood of relapse and opiate overdose and substitute pharmaceuticals for illicit drugs.

Participants: A sample of NHS substance misuse services (n = 265) listed in one or more directories of services in England, Wales and Scotland.