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injuries in their sample were more common among minority children than among Caucasian children by rates of 27.5 percent to 12.5 percent, respectively. However, when the researchers adjusted for the likelihood of abuse, minority children aged one to three years (toddlers) were significantly more likely to receive a skeletal survey and to be reported to child welfare authorities. The researchers measured likelihood of abuse by having an expert reviewer analyze medical records without knowing the child's name, race, or other identifying details. The reviewer rated each child's injury as accidental, abusive, or indeterminate.

The discrepancies between the two racial groups were most pronounced in toddlers with accidental and indeterminate injuries. Compared to their Caucasian counterparts, toddlers with accidental injuries were over five times more likely to be evaluated for child abuse, and over three times more likely to be reported to child protective services if they were African American or Latino. Below one year of age, racial disparities were not significant.

The authors had no information on the race or other characteristics of the physicians who ordered the skeletal surveys or reported the suspected abuse. In addition, children in the study were frequently referred from community hospitals, but it was not always evident whether the survey or abuse report originated at the referring hospital or at Children's Hospital. Therefore, the authors could not analyze differences among hospitals in evaluating and reporting suspected abuse.

"In addition to suggesting that abuse is over-detected in minority children, this study suggests that cases of abuse may be missed in some Caucasian children," said Dr. Christian. "Recognizing that racial disparities exist is the first step toward health care providers correcting those discrepancies. This study is a reminder for health care providers to be as thorough and objective as possible in evaluating chil
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Contact: John Ascenzi
Ascenzi@email.chop.edu
215-590-7332
Children's Hospital of Philadelphia
1-Oct-2002

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