Citation

Mash C, Frazier T, Nowacki A, Worley S, Goldfarb J. Pediatrics 2011; 128(6): e1467-73.

Affiliation

Lerner College of Medicine and.

Copyright

(Copyright © 2011, American Academy of Pediatrics)

DOI

10.1542/peds.2011-1080

PMID

22123876

Abstract

Objective:To develop a risk-stratification tool to help identify medical child abuse (MCA) in children evaluated for failure to thrive (FTT).Patients and Methods:In this case-control study, the control group consisted of children who were seen in the pediatric gastroenterology department and diagnosed with FTT before the age of 5 years between 2000 and 2010. Cases were distinguished by having also been referred to the Child Advocacy Committee at the Cleveland Clinic Foundation (CCF) and/or reported to the Department of Child and Family Services by the CCF as a possible case of MCA. We used retrospective chart review to compare 17 cases of MCA with 68 controls. Classification-tree analysis was used to generate the risk-stratification tool.Results:A risk-stratification tool, in the form of a classification tree, was developed and incorporated the following individual risk indicators: (1) ≥5 organ systems involved; (2) absence of serious congenital anomaly or confirmed genetic disorder; (3) ≥5 reported allergies; and (4) refusal of services from a multidisciplinary feeding team. Overall, the classification tree had a sensitivity of 100% and a specificity of 96%.Conclusions:The results of this study suggest that a diagnosis of MCA may be suspected in children with FTT on the basis of features in the initial presentation and clinical course. Using the proposed riskstratification tool that incorporates these features might assist in earlier identification of medically abused children and reduce morbidity and mortality.

Language: en