title: Recurrent concerns for child abuse: repeated consultations by a subspecialty child abuse team.
abstract: Physically abused children may be repeatedly reported to child protection services and undergo multiple medical evaluations. Less is known about recurrent evaluations by hospital-based child abuse teams for possible abuse. The objectives of this study were to determine the frequency of repeated consultations by child abuse teams and to describe this cohort in terms of injury pattern, perceived likelihood of abuse, disposition plan, and factors related to repeat consultation. This was a prospectively planned, secondary analysis of data from the Examining Siblings to Recognize Abuse (ExSTRA) research network. Subjects included children younger than 10 years of age who were referred to child abuse subspecialty teams at one of 20 U.S. academic centers. Repeat consultations occurred in 101 (3.5%; 95% CI 2.9-4.2%) of 2890 subjects. The incidence of death was 4% (95% CI 1-9%) in subjects with repeated consults and 3% (95% CI 2-3%) in subjects with single consults. Perceived likelihood of abuse from initial to repeat visit remained low in 33% of subjects, remained high in 24.2% of subjects, went from low to high in 16.5%, and high to low in 26.4% of subjects. Themes identified among the subset of patients suspected of repeated abuse include return to the same environment, failure to comply with a safety plan, and abuse in foster care. Repeated consultation by child abuse specialists occurs for a minority of children. This group of children may be at higher risk of subsequent abuse and may represent an opportunity for quality improvement.
authors.affiliation: Department of Emergency Medicine, SUNY Downstate, 450 Clarkson Avenue, Box 1228, Brooklyn, NY 11203, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Martindale
authors.affiliation: Children's Hospital of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Swenson
authors.affiliation: Cook Children's Medical Center, 801 7th Avenue, Fort Worth, TX 76104, USA.
authors.forename: Jamye
authors.initials: J
authors.lastname: Coffman
authors.affiliation: Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Alice W
authors.initials: AW
authors.lastname: Newton
authors.affiliation: Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, 13123 East 16th Avenue B390, Aurora, CO 80045, USA; The Department of Emergency Medicine, University of Colorado School of Medicine, 13123 East 16th Avenue B390, Aurora, CO 80045, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Lindberg
mesh_terms: D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013038:Specialization; D014481:United States / Q000453:epidemiology
keywords: Abuse; Child protection; Foster care; Maltreatment