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Many cases of child abuse can be missed in the emergency department

Robin Wulffson MD's picture
child abuse, emergency department, detection, training, checklist

Children who present at the emergency department with an injury may be victims of child abuse; however, busy healthcare workers may overlook that possibility and merely treat the injury. A new study by researchers in The Netherlands conducted a study to determine whether introducing screening, and training of emergency department nurses, can increase the detection rate of child abuse.

They published their findings online on August 27 in the journal Pediatrics.

The authors noted that systematic screening for child abuse of children presenting at emergency departments might increase the detection rate; however, studies to support this premise are scarce. Therefore, they designed a study investigates whether introducing screening, and training of emergency department nurses, increases the detection rate of child abuse.

The study group was comprised of 104,028 children aged 18 or younger who presented at the emergency departments of seven hospitals between February 2008 and December 2009. The researchers developed a screening checklist for child abuse (the “Escape Form”) and training sessions for nurses. Cases of suspected child abuse were determined by an expert panel using predefined criteria. The effect of the interventions on the screening rate for child abuse was calculated by interrupted time-series analyses and by the odds ratios for detection of child abuse in screened children.

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The researchers found that t screening rate increased from 20% in February 2008 to 67% in December 2009. They found that significant increases in child abuse detection by the nurse after they received training as well as the legal requirement of screening by the Dutch Health Care Inspectorate in 2009. The detection rate in children screened for child abuse was five times higher than that in children not screened (0.5% vs. 0.1%).

The authors concluded that their results indicated that systematic screening for child abuse in emergency departments is effective in increasing the detection of suspected child abuse. They added that both a legal requirement and staff training are recommended to significantly increase the extent of screening.

The emergency department checklist

  • Is the history consistent?
  • Was there unnecessary delay in seeking medical help?
  • Does the onset of the injury fit with the developmental level of the child? Is the behavior of the child/the carers and the interaction appropriate?
  • Are the findings of the top-to-toe examination in accordance with the history?
  • Are there any other signals that make you doubt the safety of the child or other family members? If ‘Yes’ describe the signals in the box ‘Other comments’ below.

Take home message:
This study addresses the important issue of child abuse. Of equal importance, the checklist also appears to take into consideration that an injury that might be due to child abuse could also merely be an accident. On occasion, innocent parent is wrongly accused of child abuse by a healthcare professional.

Reference: Pediatrics