{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:55:27Z","timestamp":1784289327617,"version":"3.55.0"},"reference-count":21,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,4,1]]},"abstract":"<jats:p>OBJECTIVES. In the absence of a gold standard, clinicians and researchers often categorize their opinions of the likelihood of inflicted injury using several ordinal scales. The objective of this protocol was to determine the reliability of expert ratings using several of these scales.<\/jats:p><jats:p>METHODS. Participants were pediatricians with substantial academic and clinical activity in the evaluation of children with concerns for physical abuse. The facts from several cases that were referred to 1 hospital's child abuse team were abstracted and recorded as in a multidisciplinary team conference. Participants viewed the recording and rated each case using several scales of child abuse likelihood.<\/jats:p><jats:p>RESULTS. Participants (n = 22) showed broad variability for most cases on all scales. Variability was lowest for cases with the highest aggregate concern for abuse. One scale that included examples of cases fitting each category and standard reporting language to summarize results showed a modest (18%\u201323%) decrease in variability among participants. The interpretation of the categories used by the scales was more consistent. Cases were rarely rated as \u201cdefinite abuse\u201d when likelihood was estimated at \u226495%. Only 7 of 156 cases rated \u226415% likelihood were rated as \u201cno reasonable concern for abuse.\u201d Only 9 of 858 cases rated \u226535% likelihood were rated as \u201creasonable concern for abuse.\u201d<\/jats:p><jats:p>CONCLUSIONS. Assessments of child abuse likelihood often show broad variability between experts. Although a rating scale with patient examples and standard reporting language may decrease variability, clinicians and researchers should be cautious when interpreting abuse likelihood assessments from a single expert. These data support the peer-review or multidisciplinary team approach to child abuse assessments.<\/jats:p>","DOI":"10.1542\/peds.2007-2485","type":"journal-article","created":{"date-parts":[[2008,4,1]],"date-time":"2008-04-01T20:25:58Z","timestamp":1207081558000},"page":"e945-e953","source":"Crossref","is-referenced-by-count":110,"title":["Variability in Expert Assessments of Child Physical Abuse Likelihood"],"prefix":"10.1542","volume":"121","author":[{"given":"Daniel Martin","family":"Lindberg","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher John","family":"Lindsell","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University Hospital\u2013Cincinnati"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert Allan","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2008,4,1]]},"reference":[{"key":"2021120902165748300_R1","doi-asserted-by":"crossref","unstructured":"Feldman KW, Bethel R, Shugerman RP, Grossman DC, Grady MS, Ellenbogen RG. The cause of infant and toddler subdural hemorrhage: a prospective study. Pediatrics.\u20082001;108(3):636\u2013646","DOI":"10.1542\/peds.108.3.636"},{"key":"2021120902165748300_R2","doi-asserted-by":"crossref","unstructured":"Strait RT, Siegel RM, Shapiro RA. Humeral fractures without obvious etiologies in children less than 3 years of age: when is it abuse?Pediatrics.\u20081995;96(4 Pt 1):667\u2013671","DOI":"10.1542\/peds.96.4.667"},{"key":"2021120902165748300_R3","doi-asserted-by":"crossref","unstructured":"Leventhal JM, Thomas SA, Rosenfield NS, Markowitz RI. Fractures in young children: distinguishing child abuse from unintentional injuries. Am J Dis Child.\u20081993;147(1):87\u201392","DOI":"10.1001\/archpedi.1993.02160250089028"},{"key":"2021120902165748300_R4","doi-asserted-by":"crossref","unstructured":"Thomas SA, Rosenfield NS, Leventhal JM, Markowitz RI. Long-bone fractures in young children: distinguishing accidental injuries from child abuse. Pediatrics.\u20081991;88(3):471\u2013476","DOI":"10.1542\/peds.88.3.471"},{"key":"2021120902165748300_R5","doi-asserted-by":"crossref","unstructured":"Duhaime AC, Alario AJ, Lewander WJ, et al. Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics.\u20081992;90(2 Pt 1):179\u2013185","DOI":"10.1542\/peds.90.2.179"},{"key":"2021120902165748300_R6","doi-asserted-by":"crossref","unstructured":"Laskey AL, Sheridan MJ, Hymel KP. Physicians' initial forensic impressions of hypothetical cases of pediatric traumatic brain injury. Child Abuse Negl.\u20082007;31(4):329\u2013342","DOI":"10.1016\/j.chiabu.2006.02.017"},{"key":"2021120902165748300_R7","doi-asserted-by":"crossref","unstructured":"Levi BH, Brown G. Reasonable suspicion: a study of Pennsylvania pediatricians regarding child abuse. Pediatrics.\u20082005;116(1). Available at: www.pediatrics.org\/cgi\/content\/full\/116\/1\/e5","DOI":"10.1542\/peds.2004-2649"},{"key":"2021120902165748300_R8","doi-asserted-by":"crossref","unstructured":"Levi BH, Brown G, Erb C. Reasonable suspicion: a pilot study of pediatric residents. Child Abuse Negl.\u20082006;30(4):345\u2013356","DOI":"10.1016\/j.chiabu.2005.05.004"},{"key":"2021120902165748300_R9","doi-asserted-by":"crossref","unstructured":"Billmire M, Myers P. Serious head injury in infants: accident or abuse. Pediatrics.\u20081985;75(2):340\u2013342","DOI":"10.1542\/peds.75.2.340"},{"key":"2021120902165748300_R10","doi-asserted-by":"crossref","unstructured":"Paradise JE, Finkel MA, Beiser AS, Berenson AB, Greenberg DB, Winter MR. Assessments of girl's genital findings and the likelihood of sexual abuse: agreement among physicians self-rated as skilled. Arch Pediatr Adolesc Med.\u20081997;151(9):883\u2013891","DOI":"10.1001\/archpedi.1997.02170460021004"},{"key":"2021120902165748300_R11","doi-asserted-by":"crossref","unstructured":"Roberts I, Moran K. Inter-rater reliability in the medical diagnosis of child sexual abuse. J Paediatr Child Health.\u20081995;31(4):290\u2013291","DOI":"10.1111\/j.1440-1754.1995.tb00813.x"},{"key":"2021120902165748300_R12","doi-asserted-by":"crossref","unstructured":"Southall DP, Stebbens VA, Rees SV, Lang MH, Warner JO, Shinebourne EA. Apnoeic episodes induced by smothering: two cases identified by covert video surveillance. Br Med J (Clin Res Ed).\u20081987;294(6588):1637\u20131641","DOI":"10.1136\/bmj.294.6588.1637"},{"key":"2021120902165748300_R13","doi-asserted-by":"crossref","unstructured":"Falcone RA Jr, Brown RL, Garcia VF. Disparities in child abuse mortality are not explained by injury severity. J Pediatr Surg.\u20082007;42(6):1031\u20131037","DOI":"10.1016\/j.jpedsurg.2007.01.038"},{"key":"2021120902165748300_R14","doi-asserted-by":"crossref","unstructured":"Hymel KP, Makoroff KL, Laskey AL, Conaway MR, Blackman JA. Mechanisms, clinical presentations, injuries, and outcomes from inflicted versus noninflicted head trauma during infancy: results of a prospective, multicentered, comparative study. Pediatrics.\u20082007;119(5):922\u2013929","DOI":"10.1542\/peds.2006-3111"},{"key":"2021120902165748300_R15","doi-asserted-by":"crossref","unstructured":"Taggart NW, Haglund CM, Tester DJ, Ackerman MJ. Diagnostic miscues in congenital long-QT syndrome. Circulation.\u20082007;115(20):2613\u20132620","DOI":"10.1161\/CIRCULATIONAHA.106.661082"},{"key":"2021120902165748300_R16","doi-asserted-by":"crossref","unstructured":"Elesber AA, Decker WW, Smars PA, Hodge DO, Shen WK. Impact of the application of the American College of Emergency Physicians recommendations for the admission of patients with syncope on a retrospectively studied population presenting to the emergency department. Am Heart J.\u20082005;149(5):826\u2013831","DOI":"10.1016\/j.ahj.2004.07.024"},{"key":"2021120902165748300_R17","doi-asserted-by":"crossref","unstructured":"Patel MR, Chen AY, Roe MT, et al. A comparison of acute coronary syndrome care at academic and nonacademic hospitals. Am J Med.\u20082007;120(1):40\u201346","DOI":"10.1016\/j.amjmed.2006.10.008"},{"key":"2021120902165748300_R18","doi-asserted-by":"crossref","unstructured":"Kostis WJ, Demissie K, Marcella SW, Shao YH, Wilson AC, Moreyra AE. Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med.\u20082007;356(11):1099\u20131109","DOI":"10.1056\/NEJMoa063355"},{"key":"2021120902165748300_R19","doi-asserted-by":"crossref","unstructured":"Frampton AE, Eynon CA. High dose methylprednisolone in the immediate management of acute, blunt spinal cord injury: what is the current practice in emergency departments, spinal units, and neurosurgical units in the UK?Emerg Med J.\u20082006;23(7):550\u2013553","DOI":"10.1136\/emj.2005.032698"},{"key":"2021120902165748300_R20","doi-asserted-by":"crossref","unstructured":"Belliard G, Catez E, Charron C, et al. Efficacy of therapeutic hypothermia after out-of-hospital cardiac arrest due to ventricular fibrillation. Resuscitation.\u20082007;75(2):252\u2013259","DOI":"10.1016\/j.resuscitation.2007.04.014"},{"key":"2021120902165748300_R21","unstructured":"Wennberg JE, Fisher ES, Sharp SM, et al. The Care of Patients With Severe Chronic Illness: The Dartmouth Atlas of Health Care 2006. Available at: www.dartmouthatlas.org. Accessed September 21, 2007"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/121\/4\/e945\/1122609\/zpe0040800e945.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/121\/4\/e945\/1122609\/zpe0040800e945.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T11:30:28Z","timestamp":1684323028000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/121\/4\/e945\/70963\/Variability-in-Expert-Assessments-of-Child"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,4,1]]},"references-count":21,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2008,4,1]]},"published-print":{"date-parts":[[2008,4,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2007-2485","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,4,1]]}}}