XXXX in young @entity1 : are physicians in the emergency department and orthopedic clinics adequately screening for possible abuse?

@entity1 @entity130 @entity174
OBJECTIVES: 1) To determine whether physicians are sufficiently investigating the cause of @entity174 in @entity1 younger than 3 years and 2) to find out what influences physicians' quality of history taking and documentation necessary to rule out inflicted @entity130 . DESIGN: Descriptive, retrospective chart review. SETTING: Pediatric emergency department and orthopedic clinic of an urban teaching hospital. SUBJECTS: @entity1 younger than 3 years treated between January 1, 1995, and December 31, 1998, presenting with a @entity174 . RESULTS: A total of 653 charts met entry criteria. Information that was significantly lacking in the recorded history included witness presence, history of previous injury, review of past medical record, other @entity130 , and whether the injury was consistent with the development of the @entity1 . It was not possible to rule out inflicted injury in 42% of the @entity1 . Four groups emerged from the entire cohort: group 1, accidental @entity130 , which made up 63% of the entire group (n = 413); group 2, inflicted @entity130 , which made up 13% (n = 85); group 3, missed inflicted @entity130 , which made up 23% (n = 151); and group 4, missed accidental @entity130 , which made up 0.6% (n = 4). Younger age of the @entity1 , @entity174 , need for hospital admission, and the examining physician being a pediatrician positively influenced physicians' propensity to accurately report inflicted @entity130 . CONCLUSIONS: A large percentage of the charts reviewed contained inadequate documentation to explain the cause of @entity174 and thereby rule out inflicted @entity130 . Information in 23% of the charts reviewed aroused suspicion of inflicted @entity130 . There is a need to ensure that adequate information is obtained and documented in hospital records to rule out inflicted injury. This will require changes in the knowledge, skills, and attitudes of physicians. The use of forms, protocols, and periodic chart review will help to ensure compliance.
