The purpose of this study was to evaluate the efficacy and accuracy of mandated reporters to identify child abuse in children presenting with fractures. An Institutional Review Board approved survey-based study between January 2017 and December 2017 was conducted at a tertiary care academic medical center. 10 cases were combined to create one survey. Each case had information on presentation history, radiographic data, and social history. This study assesses the ability of 13 orthopedic residents and 11 medical students to diagnose child abuse. Participants had the option to explain their reasoning for a given case. To evaluate decision-making reasoning, we split responses into three cohorts, encompassing objective evidence, subjective evidence, or social evidence. Twenty-four participants completed the survey; 203 out of 240 (85%) included the rationale for the diagnosis of child abuse. The observed diagnostic odds ratio was 0.83 for medical students, 0.93 for junior residents, and 0.96 for senior residents. There was no statistically significant difference in diagnosing child abuse between a participant’s level of experience, age, or whether participants had their own children. Participants who used more than one source of evidence were significantly more likely to make the correct diagnosis (P = 0.013). Participant decisions were no more accurate than a coin toss. The use of several data sources led to increased diagnostic accuracy. There is low accuracy in correctly diagnosing child abuse in our cohort of mandated reporters. Participants who highlighted using several sources of evidence were more likely to diagnose child abuse accurately.

本研究的目的是评估授权报告者识别骨折儿童虐待儿童的有效性和准确性。2017 年 1 月至 2017 年 12 月期间，机构审查委员会批准了一项基于调查的研究，该研究在三级护理学术医疗中心进行。将 10 个案例合并为一项调查。每个病例都有关于表现史、放射学数据和社会史的信息。本研究评估了 13 名骨科住院医师和 11 名医学生诊断虐待儿童的能力。参与者可以选择解释他们对特定案例的推理。为了评估决策推理，我们将响应分为三组，包括客观证据、主观证据或社会证据。24 名参与者完成了调查；240 人中有 203 人 (85%) 包括诊断虐待儿童的理由。观察到的医学生诊断优势比为 0.83，初级住院医师为 0.93，老年住院医师为 0.96。参与者的经验水平、年龄或参与者是否有自己的孩子在诊断虐待儿童方面没有统计学上的显着差异。使用不止一种证据来源的参与者做出正确诊断的可能性显着增加（P = 0.013）。参与者的决定并不比抛硬币更准确。多个数据源的使用提高了诊断的准确性。在我们的授权记者队列中，正确诊断虐待儿童的准确性很低。强调使用多种证据来源的参与者更有可能准确诊断虐待儿童。