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Child Maltreat. 2015 May;20(2):141-5. doi: 10.1177/1077559514566450. Epub 2015 Jan 18.

The association of the rapid assessment of supervision scale score and unintentional childhood injury.

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Division of Child Abuse and Neglect, Children's Mercy Hospital, Kansas City, MO, USA
The University of Kansas School of Medicine, Kansas City, KS, USA.
Division of Emergency Medicine, Children's Mercy Hospital, Kansas City, MO, USA.
Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
School of Nursing, University of Missouri, Columbia, MO, USA.


Supervisory neglect is often considered in medical settings when a child presents with an unintentional injury. The Rapid Assessment of Supervision Scale (RASS) is a clinical decision-making tool for the assessment of supervision of young children. As the next step in the development of the RASS, we assessed the association of RASS scores with unintentional injury. This study was a secondary analysis of data from a case-crossover study, which examined the association of parental supervision and unintentional injury in children. Data on supervision characteristics for 3 time periods for each child were available, that is, one injury scenario and two "control" time periods when no injury occurred. Blinded to injury status, four raters independently evaluated adequacy of supervision in 132 supervision scenarios using the RASS. The individual RASS scores of the four raters and the group (mean) RASS score of the four raters were evaluated for associations with injury status. Individual scores from three of the four raters demonstrated significant associations of increasing RASS scores with injury. Increasing group RASS scores (odds ratio = 2.8; 95% confidence interval [1.5, 5.1]) were associated with greater likelihood of injury. Further testing may result in a tool that aids medical personnel in the evaluation of adequacy of supervision.


health professionals; logistic regression; medical aspects; neglect

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