Citation

Cowley LE, Maguire S, Farewell DM, Quinn-Scoggins HD, Flynn MO, Kemp AM. Child Abuse Negl. 2018; 81: 192-205.

Affiliation

Division of Population Medicine, School of Medicine, Cardiff University, Wales, United Kingdom. Electronic address: KempAM@cardiff.ac.uk.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.chiabu.2018.04.022

PMID

29753199

Abstract

The validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) based on combinations of six clinical features: head/neck bruising; apnea; seizures; rib/long-bone fractures; retinal hemorrhages. We aimed to determine the acceptability of PredAHT to child protection professionals. We conducted qualitative semi-structured interviews with 56 participants: clinicians (25), child protection social workers (10), legal practitioners (9, including 4 judges), police officers (8), and pathologists (4), purposively sampled across southwest United Kingdom. Interviews were recorded, transcribed and imported into NVivo for thematic analysis (38% double-coded). We explored participants' evaluations of PredAHT, their opinions about the optimal way to present the calculated probabilities, and their interpretation of probabilities in the context of suspected AHT. Clinicians, child protection social workers and police thought PredAHT would be beneficial as an objective adjunct to their professional judgment, to give them greater confidence in their decisions. Lawyers and pathologists appreciated its value for prompting multidisciplinary investigations, but were uncertain of its usefulness in court. Perceived disadvantages included: possible over-reliance and false reassurance from a low score. Interpretations regarding which percentages equate to 'low', 'medium' or 'high' likelihood of AHT varied; participants preferred a precise % probability over these general terms. Participants would use PredAHT with provisos: if they received multi-agency training to define accepted risk thresholds for consistent interpretation; with knowledge of its development; if it was accepted by colleagues. PredAHT may therefore increase professionals' confidence in their decision-making when investigating suspected AHT, but may be of less value in court.

Copyright © 2018 Elsevier Ltd. All rights reserved.

Language: en

Keywords

Abusive head trauma; Child physical abuse; Child protection; Clinical prediction tool; Qualitative research