New App Aims to Improve Recognition, Treatment of Child Abuse

A new app from Ann and Robert H. Lurie Children’s Hospital of Chicago, known as LCAST (Lurie Children’s Child Injury Plausibility Assessment Support Tool), aims to enhance the process of recognizing bruises in patients under 4 years old to identify those that may derive from child abuse, thus aiding decision making.

According to the National Children’s Alliance, over 600,000 children in the US experience abuse every year.

The press release also indicated that bruising from physical abuse is often overlooked, which can lead to fatality among young children.

LCAST considers various factors related to bruising to support evidence-based decision-making. Although the app cannot serve as a tool for diagnosis, it can assist researchers in determining the instances that require a more serious level of attention.

“Bruising on a young child is often dismissed as a minor injury, but depending on where the bruise appears, it can be an early sign of child abuse,” said Mary Clyde Pierce, MD, emergency medicine physician at Lurie Children's and a professor of pediatrics and preventive medicine at Northwestern University Feinberg School of Medicine, in a press release. “We need to look at bruising in terms of risk. Our new app, LCAST, helps clinicians identify high-risk cases that warrant evaluation for child abuse. This is critical, since abuse tends to escalate, and earlier recognition can save children’s lives.”

The structure of LCAST consists of an interactive 3D rotating model of a child that allows researchers to note the body parts where the bruises are. After answering questions regarding any additional symptoms and the injury event, the researcher is given a result built upon the patient’s information that notes whether the bruise could have occurred as a result of abuse or an accident.

LCAST was created using evidence from research that received funding from the National Institutes of Health (NIH). Headed by Pierce, this research refined and validated TEN-4-FACESp, a bruising clinical decision rule that reveals the body regions where bruising is likely the result of abuse. Slingshot and BioDigital partnered with Pierce and Kim Kaczor, a senior research scientist at Lurie Children's, to develop the app.

To assess TEN-4-FACESp, Pierce, Kaczor, and other colleagues conducted a study examining more than 21,000 children, all under the age of 4, and came to five different pediatric emergency departments. 

After enrolling 2,161 patients with bruising, researchers determined that TEN-4-FACESp had a 95 percent sensitivity and an 87 percent specificity. These results indicated that the tool could accurately differentiate bruise types.

“It was very important to us to make sure that the app screening tool captures potential abuse without over-capturing innocent cases of children with bruising caused by accidental or incidental injury,” said Pierce. “We are excited that LCAST is based on highly reliable evidence, and it is practical enough to be used by clinicians in Emergency Departments, paramedics, social workers from the Department of Children and Family Services, and during any clinical encounter.”

As the prevalence of smartphones and their applications continue to grow, research indicates how this technology can play a critical role in healthcare.

Research presented at the American Stroke Association’s International Stroke Conference 2023 in February indicated that a smartphone application could leverage machine-learning algorithms to reveal stroke symptoms.

Known as FAST.AI, the app uses video to recognize facial asymmetry, sensors to determine arm weakness, and voice recordings to identify speed changes. This data is critical in determining whether a patient is experiencing stroke symptoms. The speed at which this occurs through the app could allow for more timely treatment.