Testing for bleeding disorders in child abuse: AAP recommendation adherence and testing results

Objectives: Using a multicenter child abuse pediatrics research network (CAPNET), the study objectives were to characterize the adherence to American Academy of Pediatrics (AAP) recommendations for bleeding disorder testing and the frequency of bleeding disorder identification. Methods: We performed a descriptive study of bleeding disorder evaluations among children younger than 10 years of age who presented with bruising and/or intracranial hemorrhage (ICH) concerning for abuse from February 2021–May 2022 utilizing CAPNET. Cases were classified as bruising without ICH or ICH with or without bruising. Based on AAP guidance, testing was not recommended in cases with concomitant suspicious injuries, inflicted injury history, patterned injury, and low clinical concern for abuse. The primary outcome was adherence to AAP recommendations for testing by study group. We also calculated the frequency of bleeding disorder identification. Results: A total of 2491 children presented with bruising and/or ICH concerning for abuse during the study period. 25.1 % of subjects (468 with bruising and 157 with ICH) were recommended to have testing by AAP criteria. Of these, 10.5 % cases of bruising and 33.1 % cases of ICH completed all AAP recommended testing. Among CAPNET centers, AAP recommended testing completion ranged from 0 to 34.1 % of bruising cases and 4.8–100 % of ICH cases. In total, 0.7 % (18/2491) cases had a newly identified bleeding disorder, with more identified at one center with higher testing rates. Conclusions: Testing for bleeding disorders based on AAP recommendations frequently did not occur and varied by CAPNET center. Although rare, bleeding disorders were present among cases with testing.