Work in Progress

Testing and Identification of Medical Mimics in Cases of Suspected Abuse
PI: Jim Anderst, MD

The primary objective of this project is to characterize the frequency of testing for and identification of mimics, specifically metabolic/genetic bone conditions and bleeding disorders, in cases of possible child physical abuse at CAPNET sites. Additionally, the project will characterize the predictors for testing and identification of mimics, effect of testing for such mimics on diagnostic certainty, and the relationship between bone health labs and fractures.

Workload, Utilization, and Outcomes of Child Abuse Practitioners in the CAPNET Research Network
PI: John Melville, MD

We hope to characterize the referral practices of different CAPNET centers by comparing rates of physical abuse consultation and diagnosis to institutional characteristics including ED and inpatient volumes, bed capacity, and staffing of the center’s child abuse team.

Assessing cross-site differences in abusive head trauma (AHT) evaluations, diagnosis, and reporting
PI: Kent Hymel, MD

Multiple studies have demonstrated disparity in physicians’ decisions to evaluate, diagnose, and/or report suspected abusive head trauma (AHT).  Evidence-based approaches that facilitate site-by-site comparisons of AHT evaluation, diagnosis, and reporting practices across its full clinical spectrum are lacking.  Our overall objective is to use the PediBIRN 4-variable clinical prediction rule’s evidence-based, patient-specific estimates of abuse probability to characterize and compare AHT evaluation, diagnosis, and reporting practices across participating CAPNET sites.  We hypothesize that mean/median estimates of abuse probability will not differ significantly across participating CAPNET sites in young, surviving, acutely head-injured patients: (1) evaluated thoroughly for abuse (with skeletal survey and retinal exam) vs. not evaluated thoroughly, (2) diagnosed with definitive/probable AHT vs. definitive/probable non-AHT; and (3) reported vs. not reported for suspected abuse.

Developing an ICD Coding Schema to Estimate the Burden of Physical Abuse in Emergency Departments
PI: Farah Brink, MD

The objective of this study is to combine data from Child Abuse Pediatrics Network (CAPNET) and the Pediatric Health Information System (PHIS) to develop an age-specific ICD coding schema to trend PA prevalence over time. We will first determine the accuracy of commonly used abuse-specific ICD codes for PA in EDs and at discharge if hospitalized and then will identify ICD injury codes associated with physical abuse.

Demographic and Clinical Characteristics of Patients Evaluated by Child Abuse Pediatricians for Child Physical Abuse
PI: Daniel Lindberg, MD

This is CAPNET’s core data project.  We plan to describe in a very broad way the types of patients that are seen by CAPs, the testing and interventions that are undertaken, and the early outcomes for patients at a broad level.

Evaluation and injuries for contact children
PI: Ligia Batista-Silverman

This project will determine the rates of occult injury testing that is recommended and completed for contacts of children referred for concerns of physical abuse, and rates of occult injury detection.  We will also determine child, injury and family factors that predict occult injury in contacts.

AHT in a multi-center CAP cohort — a descriptive study
PI: Stuart Sommers

This is a descriptive study of children in the CAPNET cohort who are diagnosed with AHT.  We will report the demographics, injury patterns, and early outcomes for children with AHT, and compare simple characteristics against: 1) children with TBI that is not determined by the CAP to be abusive and 2) children who present for other injuries.

Increasing the methodologic rigor in multi-center child abuse research 
PI: Angela Bachim, MD

This qualitative project aims to further define systematic differences in the populations that CAPNET captures by center. Since CAPNET inclusion criteria depends upon receiving an assessment from a child abuse team, the systematic variation in who receives a child abuse consult by each center affects how data can be combined and the assumptions that can be made from combining the data. This is important to know and further define to reduce or at least control for systemic differences in CAPNET populations by center. 

The Prevalence and Types of Prior Concerning Injuries Seen in Young Children Diagnosed with Physical Abuse
PI: Nara Cho, MD

Early recognition of concerning injuries and further evaluation in children is imperative to preventing recurrent physical abuse (PA) and ensuring a child’s safety. Currently, there is a lack of knowledge regarding frequency and types of prior injuries occurring in young children presenting with a concern for PA. The objective of this project is to assess the prevalence of prior concerning injuries in children being evaluated for physical abuse and describe the characteristics of these prior injuries.

Comparing the rates of occult fractures identified on skeletal surveys across age groups
PI: Caitlin Mcnamara

Descriptive study of the occult fracture rate identified on skeletal surveys across age groups while evaluating the clinical/demographic characteristics associated with occult fractures

Social outcomes following child abuse pediatrics consultation for suspected physical abuse
PI: Kris Campbell, MD MSc

A critical limitation of CAP research is the lack of cross-sector outcomes data to capture interventions occurring outside of the medical system. CAPNET data offer a unique description of patient centered outcomes following CAP consultation. With manual data entry of child welfare and legal outcomes, CAPNET captures early outcomes of cases of suspected child physical abuse evaluated by CAP teams for both the child (safety planning, out of home placement) and suspected perpetrator (confessions, arrests).

The objective of this project is to describe variation in short-term child welfare outcomes for children under 10 years of age with suspected physical abuse following child abuse pediatrics evaluation across a national CAP research network. We hypothesize that these outcomes will be associated with child characteristics (race and ethnicity) and ecologic factors (county level poverty and rurality).

Understanding the Current Role of Diagnosing Occult Abdominal Trauma in the Evaluation of Child Physical Abuse
PI: Tagrid Ruiz-Maldonado, MD

While current literature suggests that transaminase screening optimizes sensitivity and specificity in detection of occult abdominal trauma (OAT), we recognize meaningful disagreements among CAPs related to indications of screening, appropriate cutoffs for definitive testing, and the significance of OAT diagnosis for key patient-centered outcomes. This project aims to determine the current role of transaminase testing and abdominal imaging in CAP evaluations for child physical abuse. Additionally, it aims to determine the yield of elevated LFT (>80 IU/L) in identifying occult abdominal trauma and the influence of OAT identification in CAP level of concern during child physical abuse evaluations.

Risk stratification in sibling-at-risk evaluations for child maltreatment
PI: Tagrid Ruiz-Maldonado, MD

Current guidelines recommend a medical evaluation for close contacts of index children with injuries concerning for child physical abuse. While prior research has revealed disagreement between caseworkers and physicians regarding the need for such medical evaluation, findings suggest agreement that limited resources should be directed towards those with the highest risk. Available research would suggest that injury severity and age in the index child, as well as age in the contact child influences the risk of concurrent abuse. We believe that understanding the yield of these evaluation may help physicians guide their recommendations and would also help caseworkers understand and organize the urgency of such evaluations. This study aims to determine the yield of skeletal survey in close contacts, stratifying by severity of injury, age of contact child, and age of index child. Furthermore, we will evaluate whether interactions between these variables exists.

Optimizing targeted, equitable use of neuroimaging in cases of suspected infant physical abuse
PI: M Katherine (Kate) Henry

Infants with injuries concerning for abuse (e.g., extremity fracture) can have additional important injuries (e.g., brain injuries, certain additional fractures) that are clinically occult and only revealed with imaging. While neuroimaging with CT or MRI can identify clinically occult head injuries from abusive head trauma, clinicians must weigh the neuroimaging-associated risks of sedation or radiation with the risks of missing a clinically or forensically important injury, while having limited clinical guidance to inform their decisions.  The goal of this study is to leverage the rich clinical data available in CAPNET to develop a clinical decision rule (CDR) that identifies which well-appearing infants undergoing abuse evaluations are at high risk of intracranial injury from abusive head trauma and warrant neuroimaging. The proposed research is part of a Career Development Award (K08) funded by the Agency for Healthcare Research and Quality (AHRQ). 

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