Classifying Injuries in Young Children as Abusive or Accidental: Reliability and Accuracy of an Expert Panel Approach - 22/06/18
, Mary Clyde Pierce, MD 2, 3, Kim Kaczor, MS 2, Rachel P. Berger, MD, MPH 4, Gina Bertocci, PhD, PE 5, Bruce E. Herman, MD 6, Sandra Herr, MD 7, Kent P. Hymel, MD 8, Carole Jenny, MD, MBA 9, John M. Leventhal, MD 10, Karen Sheehan, MD, MPH 2, 3, Noel Zuckerbraun, MD, MPH 4Abstract |
Objective |
To assess interrater reliability and accuracy of an expert panel in classifying injuries of patients as abusive or accidental based on comprehensive case information.
Study design |
Data came from a prospective, observational, multicenter study investigating bruising characteristics of children younger than 4 years. We enrolled 2166 patients with broad ranges of illnesses and injuries presenting to one of 5 pediatric emergency departments in whom bruises were identified during examination. We collected comprehensive data regarding current and past injuries and illnesses, and provided deidentified, standardized case information to a 9-member multidisciplinary panel of experts with extensive experience in pediatric injury. Each panelist classified cases using a 5-level ordinal scale ranging from definite abuse to definite accident. Panelists also assessed whether report to child protective services (CPS) was warranted. We calculated reliability coefficients for likelihood of abuse and decision to report to CPS.
Results |
The interrater reliability of the panelists was high. The Kendall coefficient (95% CI) for the likelihood of abuse was 0.89 (0.87, 0.91) and the kappa coefficient for the decision to report to CPS was 0.91 (0.87, 0.94). Reliability of pairs and subgroups of panelists were similarly high. A panel composite classification was nearly perfectly accurate in a subset of cases having definitive, corroborated injury status.
Conclusions |
A panel of experts with different backgrounds but common expertise in pediatric injury is a reliable and accurate criterion standard for classifying pediatric injuries as abusive or accidental in a sample of children presenting to a pediatric emergency department.
Le texte complet de cet article est disponible en PDF.Keywords : child abuse, criterion standard classification
Abbreviations : CPS, PED
Plan
| Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD060997 to M.P.) and by The Grainger Foundation. B.H. received payment for expert witness record review and testimony related to children with concern for abuse. G.B. received payment for expert testimony in cases of pediatric injury. The Yale Department of Pediatrics received payment for J.L.'s expert testimony related to children with concern for abuse. University of Pittsburgh Physicians (UPP) received payment for R.B.'s expert testimony related to children with concern for abuse. The other authors declare no conflicts of interest. |
Vol 198
P. 144 - juillet 2018 Retour au numéro
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