The influence of case and professional variables on identification and reporting of physical abuse: a study with medical students.

Identification and reporting of suspected cases of maltreatment are important precursors to intervention, as maltreating parents typically do not self-refer for treatment. Professionals from various disciplines are legally mandated to report suspected cases of child maltreatment, yet incidences of abuse can remain unidentified or unreported. Identification of physical abuse often depends on careful consideration of the characteristics of the injuries and the plausibility of the explanations provided for the injuries. Many variables impact identification, as well as the subsequent decision of whether or not to report the case if abuse is suspected. The study examined the influence of three case variables (injury severity, plausibility of explanation, and time to seek medical attention) and two professional variables (gender of subject and amount of clinical experience) on how medical students respond to hypothetical cases of abuse. As part of the study, the responses of medical students were compared to those of practicing physicians. Subjects evaluated 16 different vignettes, each describing an injured child, rated whether injuries may have resulted from physical abuse, and indicated what further action should be taken with the case, including whether it should be reported. Results indicated a significant three-way interaction between injury severity, injury explanation, and delay. Subject gender and amount of clinical experience did not influence identification. Significant positive correlations between identification and reporting were found. Correspondence between the responses of medical students and physicians was quite strong. Implications for clinical training of mandated reporters and directions for future research are discussed.