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Multicenter Study
. 2016 Mar 22;6(3):e010788.
doi: 10.1136/bmjopen-2015-010788.

Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study

Judith S Sittig  1 , Cuno S P M Uiterwaal  2 , Karel G M Moons  2 , Ingrid M B Russel  3 , Rutger A J Nievelstein  4 , Edward E S Nieuwenhuis  3 , Elise M van de Putte  3
Affiliations
Multicenter Study

Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study

Judith S Sittig et al. BMJ Open. .

Abstract

Objectives: The aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury.

Design: A large multicentre study with a 6-month follow-up.

Setting: 4 ERs in The Netherlands.

Participants: 4290 children aged 0-7 years attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test). A national expert panel (reference standard) retrospectively assessed all children with positive screens and a 15% random sample of the children with negative screens for physical abuse, using additional information, namely, an injury history taken by a paediatrician, information provided by the general practitioner, youth doctor and social services by structured questionnaires, and 6-month follow-up information.

Main outcome measure: Physical child abuse.

Secondary outcome measure: Injury due to neglect and need for help.

Results: 4253/4290 (99%) parents agreed to follow-up. At a prevalence of 0.07% (3/4253) for inflicted injury by expert panel decision, the positive predictive value of the checklist was 0.03 (95% CI 0.006 to 0.085), and the negative predictive value 1.0 (0.994 to 1.0). There was 100% (93 to 100) agreement about inflicted injury in children, with positive screens between the expert panel and child abuse experts.

Conclusions: Rare cases of inflicted injury among preschool children presenting at ERs for injury are very likely captured by easy-to-use checklists, but at very high false-positive rates. Subsequent assessment by child abuse experts can be safely restricted to children with positive screens at very low risk of missing cases of inflicted injury. Because of the high false positive rate, we do advise careful prior consideration of cost-effectiveness and clinical and societal implications before de novo implementation.

Keywords: ACCIDENT & EMERGENCY MEDICINE; EPIDEMIOLOGY.

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Figures

Figure 1
Figure 1
SPUTOVAMO-R (index test).
Figure 2
Figure 2
Different steps of the diagnostic outcome assessment by consensus of the expert panel (reference standard).
Figure 3
Figure 3
Flow chart inclusion Child Abuse Inventory at Emergency Rooms.
See this image and copyright information in PMC

References

    1. Woodman J, Pitt M, Wentz R et al. . Performance of screening tests for child physical abuse in accident and emergency departments. Health Technol Assess 2008;12:iii, xi–xiii 1–95 10.3310/hta12330 - DOI - PubMed
    1. Gilbert R, Widom CS, Browne K et al. . Burden and consequences of child maltreatment in high-income countries. Lancet 2009;373:68–81. 10.1016/S0140-6736(08)61706-7 - DOI - PubMed
    1. Norman RE, Byambaa M, De R et al. . The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Med 2012;9:e1001349 10.1371/journal.pmed.1001349 - DOI - PMC - PubMed
    1. Gilbert R, Kemp A, Thoburn J et al. . Recognising and responding to child maltreatment. Lancet 2009;373:167–80. 10.1016/S0140-6736(08)61707-9 - DOI - PubMed
    1. Louwers EC, Affourtit MJ, Moll HA et al. . Screening for child abuse at emergency departments: a systematic review. Arch Dis Child 2010;95:214–18. 10.1136/adc.2008.151654 - DOI - PubMed

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