Inflicted versus unintentional injury: towards improved detection and surveillance of supervisory neglect

Space: StayCurrentMD Author: David M Notrica, Lois W Sayrs, Lisa Kirsch, Cara Kelly, Todd Nickoles, Jodie Greenberg, Maria Valdez, Andrea Fernandez, Nidhi Krishna, Shivani Misra Published:

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David M Notrica, Lois W Sayrs, Lisa Kirsch, Cara Kelly, Todd Nickoles, Jodie Greenberg, Maria Valdez, Andrea Fernandez, Nidhi Krishna, Shivani Misra

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Abstract

Background

Many children evaluated for child abuse have non-inflicted injuries due to supervisory neglect. Despite its prevalence, supervisory neglect has received minimal attention.

Methods

We performed a retrospective review of patients maintained in a hospital forensic registry. Text analytics software was used to classify types of supervisory neglect from reported mechanism of injury (MOI). Logistic regression was used to assess risks associated with supervisory neglect.

Results

For 1185 eligible patients, 553 were classified as having unintentional injuries. Text analysis identified four types of supervisory neglect for falls (N = 376): interrupted supervision (53.4%); failure to adapt the home (26.7%); safety equipment non-compliance (12.8%); inadequate substitute care (7.0%); a fifth category was identified for non-falls (N = 54): rough handling (32.0%). Supervisory neglect was associated with MOI consistent with the injury (AOR = 15.5[p 

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