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- Title
Racial Differences in the Evaluation of Pediatric Fractures for Physical Abuse.
- Authors
Lane, Wendy G.; Rubin, David M.; Monteith, Ragin; Christian, Cindy W.
- Abstract
Context: Child maltreatment is a significant problem within US society, and minority children have higher rates of substantiated maltreatment than do white children. However, it is unclear whether minority children are abused more frequently than whites or whether their cases are more likely to be reported. Objectives: To determine whether there are racial differences in the evaluation and Child Protective Services (CPS) reporting of young children hospitalized for fractures. Design, Setting, and Patients: Retrospective chart review conducted at an urban US academic children's hospital among 388 children younger than 3 years hospitalized for treatment of an acute primary skull or long-bone fracture between 1994 and 2000. Children with perpetrator-admitted child abuse, metabolic bone disease, birth trauma, or injury caused by vehicular crash were excluded. Main Outcome Measures: Ordering of skeletal surveys and filing reports of suspected abuse. Results: Reports of suspected abuse were filed for 22.5% of white and 52.9% of minority children (P<.001). Abusive injuries, as determined by expert review, were more common among minority children than among white children (27.6% vs 12.5%; P<.001). Minority children aged at least 12 months to 3 years (toddlers) were significantly more likely to have a skeletal survey performed compared with their white counterparts, even after controlling for insurance status, independent expert determination of likelihood of abuse, and appropriateness of performing a skeletal survey (adjusted odds ratio [OR], 8.75; 95% confidence interval [CI], 3.48-22.03; P<.001). This group of children was also more likely to be reported to CPS compared with white toddlers, even after controlling for insurance status and likelihood of abuse (adjusted OR, 4.32; 95% CI, 1.63-11.43; P = .003). By likelihood of abuse, differential ordering of skeletal surveys and reporting of suspected abuse were most pronounced for children at least 12 months old with...
- Subjects
UNITED States; ABUSED children; CHILD abuse; RACE discrimination; CHILDREN'S injuries; BONE fractures in children; MEDICAL care
- Publication
JAMA: Journal of the American Medical Association, 2002, Vol 288, Issue 13, p1603
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.288.13.1603