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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. Child abuse pediatricians (CAPs) were significantly less likely to perform the gold standard evaluation for abuse after meeting families and examining the patient as compared to CAPs who received only demographic information, history, and physical exam results without meeting the patient or their family.

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2. CAPs were less confident in diagnosis of child abuse when unable to interact with patients and their families and when demographic information was removed from chart data.

Study Rundown:

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Clinical decision making often relies on both “intuition,” meaning the “gut-feeling” gained by interacting with a patient and their family, and “information,” or the patient’s demographic information which provides context for a patient’s pathology. Moreover, these subjective pieces of intuition and information often affect a clinician’s perception of patient’s risk, particularly for pathologies such as child abuse. In this study, researchers sought to clarify the effect both intuition and information had on the completeness of evaluation and the confidence of an abuse diagnosis as performed by CAPs. Using cases of suspected child abuse contributed by CAPs, researchers assessed the completeness of physician work-up as well as certainty of diagnosis when given graded levels of information. CAPs were more likely to perform a complete abuse work-up when given less subjective data, such as direct patient interaction and demographic information, though they rated their perception of the patient’s risk higher with more subjective information. Simultaneously, physicians were less confident in their diagnosis of child abuse when unable to examine the patient and, more so, when also blinded to demographic data. Though limited by the inherent uncertainty of the child abuse diagnosis, this study reveals a need for standard checklists to aid physicians in performing a complete evaluation when concerned about child abuse.

In-Depth:

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In this study, 32 CAPs contributed 730 cases of possible child abuse. Physicians contributing the cases had personally examined the patient, met the patient’s family, and were given full access to patient demographic information (i.e. economic status). These physicians were subsequently given blinded cases to review, with graded information available when physicians were identified as either the first reviewer (R1) or second reviewer (R2). As an R1, reviewers were given some social information, but were unable to interact with patients and were blinded to patient race. R2 reviewers, in contrast, were only given access to subjective information, such as history, physical exams, and radiographs. When ranking perceived abuse risk on a scale from 0 to 100, with 100 being greatest risk, examiners (median = 70) rated patients higher when compared both to R1 reviewers (median = 75, p < 0.05) and to R2 reviewers (median = 50, p < .01). Examiners were also more certain about diagnosis than both R1 and R2 when rating certainty on a scale from 0 to 100, with 100 being greatest certainty (median = 95, 90, 91 respectively; p < .001 for all). R2 and R1 reviewers were both more likely to perform complete work-ups when compared to examiners, with R1 being 2.17-2.23 times more likely than examiners and R2 being 2.03 to 2.60 times more likely.

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