Using simulation to identify sources of medical diagnostic error in child physical abuse

Child Abuse & Neglect
James AnderstChris Kennedy

Abstract

Little is known regarding sources of diagnostic error at the provider level in cases of possible child physical abuse. This study examines medical diagnosis as part of medical management and not as part of legal investigation. Simulation offers the opportunity to evaluate diagnostic accuracy and identify error sources. We aimed to identify sources of medical diagnostic error in cases of possible abuse by assessing diagnostic accuracy, identifying gaps in evaluation, and characterizing information used by medical providers to reach their diagnoses. Eight femur fracture simulation cases, half of which were abuse and half accident, were created. Providers from a tertiary pediatric emergency department participated in a simulation exercise involving 1 of the 8 cases. Performance was evaluated using structured scoring tools and debriefing, and qualitative analysis characterized participants' rationales for their diagnoses. Overall, 39% of the 43 participants made an incorrect diagnosis regarding abuse. An incorrect diagnosis was over 8 times more likely to occur in accident than in abuse cases (OR=8.8; 95% CI 2 to 39). Only 58% of participants correctly identified the fracture morphology, 60% correctly identified the mechanics neces...Continue Reading

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Citations

Jan 14, 2019·Archives of Disease in Childhood·Piers D MitchellGeorgina M Wright
Jun 20, 2020·European Journal of Pediatrics·Marie-Louise H J LoosWouter A Karst
Oct 26, 2018·Child Abuse & Neglect·Cynthia J Najdowski, Kimberly M Bernstein
Aug 25, 2021·Pediatrics·Jennifer HansenJames Anderst

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