US Hospitals Often Miss Signs of Child Abuse, Adherence to Screening Guidelines Vary

A new study suggests that some hospital personnel fail to conduct proper skeletal surveys on infants and toddlers with injuries associated with abuse despite the procedure's accuracy in determining these cases. The results show that only half of abused children were evaluated for occult fracture, U.S. News reports.

"In the young population, medical providers can miss important injuries. ... Skeletal surveys can help identify them," Dr. Joanne N. Wood, MD, MSHP, from the Children's Hospital of Philadelphia and the Perelman School of Medicine said, Kasier Health News has learned.

Wood and her colleagues stressed the importance of skeletal surveys in detecting occult fractures that could lead to an early discovery of child abuse. At the same time, doing so will protect the child and help them seek for additional medical services

The American Academy of Pediatrics has released a guideline, ordering doctors to do an X-ray for children under two years old with injuries that suggest possible physical abuse. An X-ray is done to examine "occult" bone fractures, which are bone breaks that are not obvious during the exam or could be old injuries that are healing on their own, U.S. News reports.

According to Wood, occult bone fractures do not necessarily require treatment. However, according to the report, doing so can help confirm suspicions of abuse.

Unfortunately, the result of the study only shows that among the children already diagnosed with abuse, only 48 percent underwent X-rays to examine hidden fractures. Similarly, for children suspected to have suffered abuse, only over half of them were screened.

Moreover, hospitals have different practices when it comes to dealing with this issue. According to U.S. News, some hospitals screen every infant with a thighbone fracture, an injury that most of the time is not associated with abuse. Others, on the other hand, screen none of those babies.

Wood admitted that they were expecting variations among hospitals but were surprised by its extent.

Among the suspected reasons are the lack of awareness of hospital personnel about the guidelines and unavailability of staff to do an X-ray, especially for children admitted at night. Although the reasons are unclear, it calls the need to standardize care for the vulnerable children.

In the same report, Dr. Kristine Campbell, an associate professor at the University of Utah, said that the study is significant because it reveals that hospitals are not following the only guideline that could assist medical practitioners to diagnose children, who are suspiciously abused physically without prejudice.

Campbell believes that the lack of adherence to the guidelines could be attributed to the lack of evidence that following it can improve the children's lives.

"Finding unexpected rib fractures in a child with abuse certainly helps to support the medical diagnosis," Campbell said. 

"Unfortunately, we can't tell you that finding the rib fracture matters in the safety and protection of the child against future abuse." She also added that other research suggested that doctors avoid making a diagnosis of abuse because of uncertainty that referring children to child protective services will improve their lives.

The study examined the data of 4,486 children younger than two years old from 336 hospitals, who are diagnosed with abuse or injuries often linked to child abuse. The results of the study was published last Monday, July 13, in "Pediatrics", Medscape has learned.