麻豆传媒

Between 2010-2014, Black children were overrepresented in suspected child abuse reporting, despite having less severe injuries, a researcher reported.

Among 4,288 suspected child abuse victims reported to the National Trauma Data Bank, those classified as Black represented 32.3% of cases despite accounting for 13% of the U.S. population in the period the study was conducted, reported Modupeola Diyaolu, MD, of Stanford University.

In contrast, white children were underrepresented in suspected child abuse reporting, accounting for 51.2% of reports, but comprising upwards of 70% of the U.S. population, Diyaolu said at the virtual American Academy of Pediatrics (AAP) meeting.

More of those classified as white had serious or severe injury severity scores (upwards of 16) compared to Black children (22% vs 11%, P<0.01) and in-hospital mortality was also significantly more common in white versus Black children (11% vs 8%, P=0.01), Diyaolu said.

Black children were also hospitalized for a longer period of time than white children, even after controlling for injury severity (5.2 vs 4.3 days, P>0.01), Diyaolu reported.

The findings suggest, "physicians are unconsciously or consciously more likely to assume child abuse in Black children, even though their injuries are less severe," Diyaolu told 麻豆传媒. "We also assume white children are being missed and are at risk of more abuse."

Children of color are for suspected child abuse, which can lead to psychological trauma and erode trust in the healthcare system, said Tiffani J. Johnson, MD, MSc, of the PolicyLab at Children's Hospital of Philadelphia (CHOP), in a separate presentation on reducing implicit bias in child abuse reporting.

In one analysis Johnson conducted, if they experienced more cognitive stressors in an emergency room shift. The finding suggests that overcrowding in emergency departments -- where child abuse detection typically occurs -- helps promote bias in clinical decision-making.

While implicit bias is less likely to influence clinical decisions when treatment protocols are specified, clinical uncertainty is a root cause for disparities, Johnson said.

"With suspected child abuse, a lot of this is more subjective," Johnson said.

Johnson cited one center that successfully for all patients who came in with unwitnessed injuries. Providers can also work on empathy-building, use counter-stereotypical examples, increase the diversity of their teams, and practice mindfulness or meditation to reduce implicit bias, she said.

In Diyaolu's study, American Indian and Alaska Native youth were also overrepresented in suspected child abuse reporting, accounting for 1.8% of reports, but 1.2% of the population during the study period. Asian children were underrepresented in suspected child abuse reporting, accounting for 1.2% of reports but close to 5% of the population, Diyaolu reported. Native Hawaiian children represented 0.2% of reports and the same proportion of the general population.

Traumatic brain injury and extremity fractures were the most common injuries reported. Black patients with suspected child abuse were more likely to be identified as having injuries to the abdomen, rib fractures, or burns compared to white patients, Diyaolu said.

Diyaolu said the next steps in her research include examining medical education to better understand how physicians are prepared to address their implicit biases and how they are affecting medical decision making.

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