Variability in choosing to report child maltreatment cases by pediatric emergency medicine physicians

Abstract

Background

Child maltreatment is a significant public health problem. Emergency departments are often the first contact points for suspected child maltreatment. Variability in the decision of whether or not to report maltreatment cases to Child Protective Services (CPS) may lead to missed opportunities for diagnosis and intervention or unnecessary medical and social interventions.

Objective

To evaluate the variability in choosing to report child maltreatment cases among emergency department physicians.

Participants

and Setting: Our survey was conducted on Emergency physicians through the [email protected] listserv

Methods

We queried emergency physicians with a 19-question survey. Seven clinical scenarios were designed by our Pediatric Emergency division in consultation with a child abuse specialist. Scenarios were created with varying degrees of suspicion for child maltreatment. Our survey asked physicians if they would report each case to CPS. We collected demographic information regarding the physician, their work setting, and their patient population. The responses for individual scenarios were analyzed as percentages and compared with demographic data by Fisher's exact test. Our survey received 307 responses.

Results

Most of our 307 respondents are specialized in pediatric emergency medicine (95.6%). Of the seven scenarios, physicians near-unanimously (99.3%, 95% CI 97.9–99.9%) agreed in only one scenario. For the other six scenarios, agreement ranged from 54.4% (95%CI: 48.8–59.9%) to 80.1% (95%CI: 75.4–84.3%). Demographics, including physician age, gender, ethnicity, years of experience, population ethnicity, and hospital location, did not explain variability in choosing to report to CPS.

Conclusion

Our study shows significant variability in reporting child maltreatment cases, not explained by hospital or physician demographics.