When Its Just a Bump on the Head: Interpreting Skull Fractures in the Context of Child Maltreatment

Biases in Diagnosis of AHT

CHAMP Education for Child Abuse Medical Providers

“Abusive head trauma (AHT) was missed significantly more often in white children than children of minority races. In white children, 43 (37.4%) of 115 cases of AHT were missed and in a minority children, 11 (19%) of 58 were missed.”

“Striking differences were seen in the race and family composition of infants with missed and recognized injuries. Infants with recognized AHT were more likely to be minority children or children whose mothers and fathers were not living together. We speculate that this may represent a subtle bias in decision making based on the physician’s assessment of risk.”

REFERENCES:

  • Jenny et al 1999

Accessible Version

We start of with the basic facts of abusive head trauma in recognizing that we miss it up to 1/3 of the time AND that part of that is due bias in medicine and how we work up child abuse. As this 1999 study by Carole Jenny et al. showed, minority children were more likely to be diagnosed with abusive head trauma than non-minority children as they were likely being worked up more often for abuse. These results are consistent with more recent studies showing a differential response and evaluation for child abuse in minority patients. It highlights the need for standardized protocols and pathways that guide provides to do the proper evaluation based on the medical literature without bias creeping in.