Are Pediatricians Applying Bias in Abuse Assessments?

A new study finds that black children are more likely to be evaluated for abuse than white children with comparable injuries, raising concerns that some young patients are subjected to unnecessary testing while other cases of abuse go undiagnosed.

Researchers from the Children’s Hospital of Philadelphia analyzed data from 3,063 infants admitted to 39 different pediatric hospitals with traumatic brain injuries not related to car accidents. After comparing the race and economic status of families with the subsequent diagnosis of child abuse after traumatic brain injury, they determined that black families and families with governmental insurance were more likely to come under scrutiny than white families and families with private insurance.

“These results show a need for the development and implementation of standard guidelines regarding who gets evaluated for abuse and neglect so we avoid these biases,” said study leader Joanne N. Wood, MD, MSHP, a pediatric researcher at The Children’s Hospital of Philadelphia, in a press report. “The concern is that we may subject children who are not getting abused to unnecessary tests and also miss actual abuse cases. We know from other studies that when physicians fail to recognize and diagnose abuse, children may suffer further abuse that results in more injury or even death.”

According to the study, which is published in Pediatrics, a little more than one-third of the infants received a diagnosis of child abuse. Black infants and publicly insured or uninsured infants were more likely to undergo tests such as skeletal surveys. However, white children were more likely to receive a diagnosis of child abuse once a skeletal survey was ordered.

“These results raise concerns that different thresholds for suspicion of child abuse were being used for children of different races and economic levels.” said David Rubin, MD, a senior author on the study. “Recognizing that racial disparities exist is the first step toward health care providers correcting those discrepancies.”

While past studies have shown these biases exist at one or a few hospitals, this is the first study to look nationally and show similar results from a wide network of pediatric hospitals.