Physician Bias May Lead to Missed Non-Accidental Trauma in Pediatric Patients
Faidah O Badru1, Saurabh Saxena1, Ngoc-Ahn Ta2, Robert Breeden1, Perry Xu2, *Colleen Fitzpatrick1, Gustavo Villalona1, Kaveer Chatoorgoon1, Jose Greenspon1
1Cardinal Glennon Children's Hospital, St Louis, MO;2St Louis University School of Medicine, St Louis, MO
Background: Non-accidental trauma (NAT) remains a diagnostic challenge. The aim of this study is to identify characteristics of pediatric patients that may predict missed NAT.Methods: A retrospective review of patients diagnosed with NAT between 2012 and 2015 was performed. Variables analyzed included demographic data, familial data, clinical data, socioeconomic factors, presence of previous traumas and patient outcomes. Patients were divided based on the presence of prior trauma not diagnosed as NAT. Those with prior trauma were considered to have had missed NAT. Result: A total of 302 patients were managed for NAT over the study period. Median age was 3 years and 54% were male. There were 29 (10.1%) patients in Group 1. The missed NAT group were more likely to be white (p = 0.02) and have comorbidities (p<0.0001). They were also more likely to require admission to intensive care unit (p<0.0001) for NAT injury management. When sub-analyzed, 27.6% patients in the missed NAT group, were considered suspicious for NAT at the time of initial assessment with children services referral made in only 13.8%. Conclusion: Race and medical comorbidities remain biases for physician diagnosis of NAT. Prior trauma is a predictor of severity of NAT. As such, a high index of suspicion should be maintained. A standard algorithm for screening, management and referral to children’s services should be used for evaluation and management of all pediatric trauma patients to minimize provider bias.
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