A SURVEY OF HEALTH-CARE AND CHILD PROTECTIVE SERVICES PROVIDER KNOWLEDGE REGARDING THE TOE TOURNIQUET SYNDROME

Recent efforts to increase public awareness of child abuse may result in an increased number of inappropriate reports of suspected child abu se. The authors believe that digital hair strangulation should be incl uded among the conditions that may be confused with child abuse. Digit al hair strangulation (toe tourniquet syndrome) occurs primarily in in fants and is characterized by a constricting band of foreign material that becomes tightly wrapped around a digit or digits (most often the toes). The consensus in the medical literature is that this condition is not the result of intentional injury. As no reference to the toe to urniquet syndrome exists in the child abuse literature, it was hypothe sized that child welfare workers would be more likely than physicians and public health nurses to misinterpret this condition as resulting f rom intentional injury. A survey was conducted to test this hypothesis . Professionals from the fields of medicine, nursing, and child welfar e were provided with a history and photographic findings of a child wi th a typical case of the toe tourniquet syndrome. Participants were su rveyed regarding their interpretation of the described injuries. More than 50% of all respondents indicated that they would report this case as suspected abuse. Child welfare workers responded that the injuries were suggestive of abuse (83%), significantly more often than public health nurses did (45%), (chi2 = 4.55, p = .03). Child welfare workers were significantly more likely to make a referral for suspected child abuse (89%) than Osteopathic physicians (56%), (chi2 = 3.8, p = .05), Allopathic physicians (53%), (chi2 = 4.28, p = .03), or public health nurses (48%), (chi2 = 6.35, p = .01). This indicates a need for infor mation regarding the toe tourniquet syndrome to appear in the child ab use literature. Recognition of the toe tourniquet syndrome may prevent unjustified reporting of child abuse.