Recognition of Abusive Head Trauma in Young Children by Emergency Physicians and Paediatricians: A Survey

Abstract

The aim of our study was to determine the physicians’ accuracy in evaluating fictitious cases of young children with high, moderate and low probability of abusive head trauma (AHT), their behaviour in reporting cases to child protection services or legal institutions, and the estimation of their own competence in the interpretating injuries in children.
Methods
Six hypothetical cases (high, moderate and low probability of AHT, with and without risk factors for abuse) were presented to physicians in a survey. The assigned probability score for AHT was compared with the calculated probability of AHT according to the PediBIRN-7 prediction tool. 
Results
The majority of physicians underestimated the probability of AHT in the cases with high probability of AHT (especially in the absence of risk factors for abuse), and overestimated the probability of AHT in cases with low probability of AHT (especially in the presence of multiple risk factors for abuse). In cases with high probability of AHT without multiple risk factors for abuse, the majority of physicians would not have reported the case. 
Conclusions
Our survey showed that the presence or absence of risk factors for abuse seemed to play a more important role in physician’s assessment of the aetiology of head injury in young children than the presence of injuries with a high specificity for AHT or accidental head injury. Unawareness of physicians´ lack of competence in evaluating injuries is a potential threat.