{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T08:20:23Z","timestamp":1792484423358,"version":"4.5.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>The objectives of this study were to assess the ability of pediatric health care providers and social workers to recognize sentinel injuries in infants under 6 months of age and to determine what factors influence their decision to evaluate for physical abuse.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A statewide collaborative focused on sentinel injuries administered a survey to pediatric health care providers and social workers in the emergency department, urgent care, and primary care. The survey contained 8 case scenarios of infants under 6 months of age with an injury, and respondents were asked if they would consider the injury to be a sentinel injury requiring a physical abuse evaluation. Respondents were then presented with several factors and asked how much each influences the decision to perform a physical abuse evaluation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 565 providers completed the survey. Providers had moderate interrater reliability on their classification of the cases as sentinel injuries or not (<jats:italic toggle=\"yes\">\u03ba<\/jats:italic> = 0.57). Nearly all respondents (97%) recognized genital bruising as a sentinel injury, whereas 77% of respondents recognized intraoral injuries. Agreement was highest among social workers (<jats:italic toggle=\"yes\">\u03ba<\/jats:italic> = 0.76) and physicians with categorical pediatrics training and pediatric emergency medicine fellowship (<jats:italic toggle=\"yes\">\u03ba<\/jats:italic> = 0.63) and lowest among nurse practitioners (<jats:italic toggle=\"yes\">\u03ba<\/jats:italic> = 0.48) and residents (<jats:italic toggle=\"yes\">\u03ba<\/jats:italic> = 0.51). Concern over missing the diagnosis of abuse had the greatest influence on the decision to perform a physical abuse evaluation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Sentinel injuries are not uniformly recognized as potential signs of child abuse requiring further evaluation by pediatric health care providers. Additional evidence and education are needed regarding sentinel injuries.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000001574","type":"journal-article","created":{"date-parts":[[2018,8,8]],"date-time":"2018-08-08T22:00:11Z","timestamp":1533765611000},"page":"e230-e235","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":17,"title":["Providers' Ability to Identify Sentinel Injuries Concerning for Physical Abuse in Infants"],"prefix":"10.1097","volume":"37","author":[{"given":"Emily A.","family":"Eismann","sequence":"first","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Shapiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Thackeray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathi","family":"Makoroff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen J.","family":"Bressler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace J.","family":"Kim","sequence":"additional","affiliation":[{"name":"University Hospitals Rainbow Babies and Children's Hospital; Case Western Reserve University School of Medicine, Cleveland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Vavul-Roediger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"McPherson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"Izsak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra P.","family":"Spencer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,8,8]]},"reference":[{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.chiabu.2011.10.006","article-title":"The economic burden of child maltreatment in the United States and implications for prevention","volume":"36","year":"2012","journal-title":"Child Abuse Negl"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1001\/jama.281.7.621","article-title":"Analysis of missed cases of abusive head trauma","volume":"281","year":"1999","journal-title":"JAMA"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1542\/peds.2008-3794","article-title":"Delayed identification of pediatric abuse-related fractures","volume":"125","year":"2010","journal-title":"Pediatrics"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1097\/PEC.0b013e3181568039","article-title":"Frena tears and abusive head injury: a cautionary tale","volume":"23","year":"2007","journal-title":"Pediatr Emerg Care"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.annemergmed.2015.06.020","article-title":"Barriers and facilitators to detecting child abuse and neglect in general emergency departments","volume":"66","year":"2015","journal-title":"Ann Emerg Med"},{"key":"bib7-20250504","first-page":"e1337","article-title":"The evaluation of suspected child physical abuse","volume":"135","year":"2015","journal-title":"Pediatrics"},{"key":"bib8-20250504","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1542\/peds.2015-1487","article-title":"Testing for abuse in children with sentinel injuries","volume":"136","year":"2015","journal-title":"Pediatrics"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"e20153024","DOI":"10.1542\/peds.2015-3024","article-title":"Development of guidelines for skeletal survey in young children with intracranial hemorrhage","volume":"137","year":"2016","journal-title":"Pediatrics"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1542\/peds.2012-2780","article-title":"Sentinel injuries in infants evaluated for child physical abuse","volume":"131","year":"2013","journal-title":"Pediatrics"},{"key":"bib11-20250504","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1093\/pch\/21.1.29","article-title":"Minor injuries\u2026major complications: watching out for sentinel injuries","volume":"21","year":"2016","journal-title":"Paediatr Child Health"},{"key":"bib12-20250504","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.pcl.2014.06.007","article-title":"Sentinel injuries: subtle findings of physical abuse","volume":"61","year":"2014","journal-title":"Pediatr Clin North Am"},{"key":"bib13-20250504","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1542\/peds.111.6.1382","article-title":"Occult head injury in high-risk abused children","volume":"111","year":"2003","journal-title":"Pediatrics"},{"key":"bib14-20250504","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1001\/archpedi.153.4.399","article-title":"Bruises in infants and toddlers: those who don't cruise rarely bruise. 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