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In all 50 states, doctors are required by law to report cases of suspected child maltreatment to child protection agencies and professionals who will further investigate and facilitate appropriate interventions, if/when necessary.
Doctors make decisions to suspect and report abuse based on their training, clinical experience, and knowledge of relevant research studies. The PediBIRN 3- and 4-variable AHT clinical decision and prediction rules provide evidence-based, patient-specific recommendations regarding abuse evaluations, and estimates of AHT probability, that must be interpreted in the context of other relevant findings and data (e.g., the presenting history, past and family medical history, familial psychosocial risk factors, the results of tests that confirm or exclude medical mimics, and input from outside investigators). In isolation, they should not be considered a sufficient foundation upon which to base expert medical opinion or courtroom testimony.
Physicians face considerable pressure to “get it right.” They understand that their failures to consider, evaluate, report, and diagnose AHT create significant risk of harm for abused children who are returned to an abusive caregiver. Physicians also understand that reporting of suspected AHT in patients who have experienced accidental trauma creates significant stress for parents and caregivers already dealing with the stress of their child’s injuries and hospitalization.
They ask doctors a few specific questions about their acutely head-injured patient, apply the answers to these questions—and evidence from multiple research studies—to sort patients into “higher risk” vs. “lower risk” categories, and recommend that every higher risk patient be thoroughly evaluated for AHT. They make no recommendations regarding abuse evaluations in the remaining lower risk patients.
They were designed to function as effective screening tests—not confirmatory tests. Effective screening tests “cast a broad net” to avoid missing a diagnosis. To miss very few patients with AHT, the PediBIRN screening tools recommend abuse evaluations for many “higher risk” patients who experienced accidental trauma. On the other hand, applying the AHT screening tools should lessen the negative impacts of physicians’ inexperience and implicit bias.
Not necessarily. Other findings not considered by the screening tools can lead to a reasonable suspicion of abuse.


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