Testing for bleeding disorders in child abuse: AAP recommendation adherence and testing results.

in Child abuse & neglect by Lyndsey Hultman, Angela Doswell, Henry T Puls, Shannon L Carpenter, Angela Bachim, Caitlin R McNamara, Farah W Brink, Lori D Frasier, Nancy S Harper, Natalie Laub, Kristine A Campbell, Daniel M Lindberg, Joanne N Wood, James Anderst

TLDR

  • The study found that doctors are not always following guidelines for testing for bleeding disorders in kids who got hurt and might have been abused, and the rates of testing vary depending on where they go to the doctor.
  • The study highlights the importance of adherence to guidelines for testing, especially in cases with intracranial hemorrhage, to ensure accurate identification of bleeding disorders.

Abstract

Using a multicenter child abuse pediatrics research network (CAPNET), the study objectives were to characterize the adherence to American Academy of Pediatrics (AAP) recommendations for bleeding disorder testing and the frequency of bleeding disorder identification. We performed a descriptive study of bleeding disorder evaluations among children younger than 10 years of age who presented with bruising and/or intracranial hemorrhage (ICH) concerning for abuse from February 2021-May 2022 utilizing CAPNET. Cases were classified as bruising without ICH or ICH with or without bruising. Based on AAP guidance, testing was not recommended in cases with concomitant suspicious injuries, inflicted injury history, patterned injury, and low clinical concern for abuse. The primary outcome was adherence to AAP recommendations for testing by study group. We also calculated the frequency of bleeding disorder identification. A total of 2491 children presented with bruising and/or ICH concerning for abuse during the study period. 25.1 % of subjects (468 with bruising and 157 with ICH) were recommended to have testing by AAP criteria. Of these, 10.5 % cases of bruising and 33.1 % cases of ICH completed all AAP recommended testing. Among CAPNET centers, AAP recommended testing completion ranged from 0 to 34.1 % of bruising cases and 4.8-100 % of ICH cases. In total, 0.7 % (18/2491) cases had a newly identified bleeding disorder, with more identified at one center with higher testing rates. Testing for bleeding disorders based on AAP recommendations frequently did not occur and varied by CAPNET center. Although rare, bleeding disorders were present among cases with testing.

Overview

  • The study aimed to investigate adherence to American Academy of Pediatrics (AAP) recommendations for bleeding disorder testing and the frequency of bleeding disorder identification in children younger than 10 years old who presented with bruising and/or intracranial hemorrhage (ICH) concerning for abuse.
  • The study used a multicenter child abuse pediatric research network (CAPNET) and included 2491 children with bruising and/or ICH who presented during the study period from February 2021 to May 2022.
  • The primary objective was to evaluate adherence to AAP recommendations for testing and the frequency of bleeding disorder identification among cases with various characteristics such as bruising, ICH, and suspicion of abuse.

Comparative Analysis & Findings

  • Among the 468 cases with bruising, 10.5% completed all AAP recommended testing, while among the 157 cases with ICH, 33.1% completed testing.
  • AAP recommended testing completion rates varied significantly among CAPNET centers, ranging from 0 to 34.1% for bruising cases and 4.8-100% for ICH cases.
  • Of the 2491 cases, 0.7% (18/2491) had a newly identified bleeding disorder, with one center having a significantly higher testing rate.

Implications and Future Directions

  • The study highlights the importance of adherence to AAP recommendations for bleeding disorder testing, especially among cases with ICH, to ensure accurate identification of bleeding disorders.
  • Future research should focus on identifying factors that contribute to the variation in testing rates among CAPNET centers and exploring ways to improve testing adherence.
  • Increased awareness and education on the importance of bleeding disorder testing for pediatricians, medical professionals, and healthcare providers may lead to improved testing rates and optimal management of bleeding disorders.
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