Development of a standardized peer review and oversight process in cases of suspected child physical abuse.

Peer review of medical opinions provided in cases of suspected child physical abuse is generally considered to be best practice for pediatricians engaged in this field. However, there are no published standardized guidelines on how pediatricians should undertake physical abuse peer review including case selection and process. Due to the high-stakes nature in the field of child abuse pediatrics, rigorous quality assurance practices and oversight mechanisms are essential to safeguard children, families, health care providers, and intersecting systems. The Suspected Child Abuse and Neglect program at The Hospital for Sick Children, Toronto, Canada developed a structured peer review process for cases of suspected physical abuse. Included in the process is an approach for the evaluation of institutional complaints received related to a child abuse pediatrician's medical opinion. This quality assurance process is presented so that other child abuse pediatricians and programs may replicate or adapt the protocol for their own local context.

Subdural hemorrhages and severe retinal hemorrhages in a short fall with a rotational component.

We present the case of a 5-month-old referred for child abuse investigation with subdural hemorrhages and extensive retinal hemorrhages following a short fall from a swivel chair seen on video footage. Subdural hemorrhages with extensive retinal hemorrhages are not typically seen as the result of short household falls. Reviewing the footage, contributing factors may have included increased rotational and deceleration forces.

Randomised trial of estimating oral endotracheal tube insertion depth in newborns using weight or vocal cord guide.

BACKGROUND: When intubating newborns, clinicians aim to position the endotracheal tube (ETT) tip in the midtrachea. The depth to which ETTs should be inserted is often estimated using the infant's weight. ETTs are frequently incorrectly positioned in newborns, most often inserted too far. Using the vocal cord guide (a mark at the distal end of the ETT) to guide insertion depth has been recommended. OBJECTIVE: To determine whether estimating ETT insertion depth using the vocal cord guide rather than weight results in more correctly positioned ETT tips. DESIGN: Single-centre randomised controlled trial. SETTING: Level III neonatal intensive care unit (NICU) at a university maternity hospital (National Maternity Hospital, Dublin, Ireland). PATIENTS: Newborn infants without congenital anomalies intubated in the NICU. INTERVENTIONS: Participants were randomised to have ETT insertion depth estimated using weight [insertion depth (cm) = weight (kg) +6] or vocal cord guide. MAIN OUTCOME MEASURE: Correct ETT position, that is, tip between the upper border of the first thoracic vertebra (T1) and the lower border of the second thoracic vertebra (T2) on a chest X-ray as determined by one paediatric radiologist masked to group assignment. RESULTS: 136 participants were randomised. The proportion of correctly positioned ETTs was similar in both groups (weight 30/69 (44%) vs vocal cord guide 27/67 (40%), p=0.731). Most incorrectly positioned ETT (69/79, 87%) were too low. CONCLUSION: Estimating ETT insertion depth using the vocal cord guide did not result in more correctly positioned ETT tips. TRIAL REGISTRATION NUMBER: ISRCTN39654846.