title: Pediatric nonaccidental injury:  are orthopedic surgeons vigilant enough?
abstract: BACKGROUND
  Nonaccidental pediatric injuries are major cause of morbidity and mortality, with fractures being second to soft-tissue injuries as the most common presentation. As the orthopedic surgeon might be the only physician an abused child would encounter, the role of the orthopedic surgeon is of great importance. It includes recognition, treatment, and appropriate report of suspected child abuse. The purpose of this study is to examine the attitude and knowledge of orthopedic surgeons treating suspected nonaccidental injuries.
  
  
  METHODS
  Evaluation of orthopedic surgeons included level of knowledge regarding pediatric nonaccidental injury, common practice, and reporting attitudes to Child Protection Services. We specifically examined whether seniority and professional experience had effect on knowledge and performance. Data were collected by a questionnaire distributed to orthopedic surgeons.
  
  
  RESULTS
  The study cohort includes 130 orthopedic surgeons. As much as 62.3% of participating physicians had 10 years or less experience practicing as orthopedic surgeons, and 37.7% had more than 10 years of experience. A mean of 2.39 cases of suspected child abuse was treated over the last year by the physicians that completed the questionnaire. Thirty-five percent of the responders had specific targeted training with respect to the "violence toward minors or helpless reporting obligation law." Of the participating physicians, 89.2% stated that they thought it is the responsibility of the orthopedic surgeons to raise the suspicion for child abuse and refer the child and his/her parents to Child Protection Services. When treating a case of suspected nonaccidental injury, 61.2% of experienced physicians stated that they try to find out what caused the symptoms as opposed to 81.5% of less-experienced physicians (P = 0.011).
  
  
  CONCLUSIONS
  The study findings suggest that many orthopedic surgeons--both senior physicians and less-experienced physicians--can benefit by improved education and training modality related to pediatric nonaccidental injury. More-experienced physicians had lesser awareness and tendency to further investigate cases with suspected nonaccidental injury compared with less-experienced physicians.
  
  
  METHODS
  Level III-retrospective study.
authors: Department of Orthopedic Surgery, The Edmond and Lilly Safra Children's Hospital, Chaim Sheba Medical Center, Tel-Hashomer, Israel. shayten@gmail.com
authors: Shay
authors: S
authors: Tenenbaum
authors: Ran
authors: R
authors: Thein
authors: Amir
authors: A
authors: Herman
authors: Ofir
authors: O
authors: Chechik
authors: Nachshon
authors: N
authors: Shazar
authors: Shmulik
authors: S
authors: Zur
authors: Abraham
authors: A
authors: Ganel
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002669:Child Welfare / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019221:Mandatory Reporting; D009985:Orthopedics / Q000379:methods / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards; D011795:Surveys and Questionnaires; D013997:Time Factors; D014947:Wounds and Injuries / Q000209:etiology*