title: Development of a risk-stratification tool for medical child abuse in failure to thrive.
abstract: OBJECTIVE
  To develop a risk-stratification tool to help identify medical child abuse (MCA) in children evaluated for failure to thrive (FTT).
  
  
  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 risk-stratification tool that incorporates these features might assist in earlier identification of medically abused children and reduce morbidity and mortality.
authors: Cleveland Clinic Children's Hospital, Cleveland, OH 44195, USA.
authors: Constance
authors: C
authors: Mash
authors: Thomas
authors: T
authors: Frazier
authors: Amy
authors: A
authors: Nowacki
authors: Sarah
authors: S
authors: Worley
authors: Johanna
authors: J
authors: Goldfarb
mesh_terms: D016022:Case-Control Studies; D002649:Child Abuse / Q000145:classification / Q000175:diagnosis*; D002675:Child, Preschool; D003663:Decision Trees; D005183:Failure to Thrive / Q000209:etiology*; D006801:Humans; D018570:Risk Assessment