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. 2017 Jan 3;12(1):e0165641.
doi: 10.1371/journal.pone.0165641. eCollection 2017.

The Value of a Checklist for Child Abuse in Out-of-Hours Primary Care: To Screen or Not to Screen

Maartje C M Schouten  1 , Henk F van Stel  2 , Theo J M Verheij  2 , Michiel L Houben  1 , Ingrid M B Russel  1 , Edward E S Nieuwenhuis  1 , Elise M van de Putte  1
Affiliations

The Value of a Checklist for Child Abuse in Out-of-Hours Primary Care: To Screen or Not to Screen

Maartje C M Schouten et al. PLoS One. .

Abstract

Objectives: To assess the diagnostic value of the screening instrument SPUTOVAMO-R2 (checklist, 5 questions) for child abuse at Out-of-hours Primary Care locations (OPC), by comparing the test outcome with information from Child Protection Services (CPS). Secondary, to determine whether reducing the length of the checklist compromises diagnostic value.

Methods: All children (<18 years) attending one of the participating OPCs in the region of Utrecht, the Netherlands, in a year time, were included. The checklist is an obligatory field in the electronic patient file. CPS provided data on all checklist positives and a sample of 5500 checklist negatives (dataset). The checklist outcome was compared with a report to CPS in 10 months follow up after the OPC visit.

Results: The checklist was filled in for 50671 children; 108 (0.2%) checklists were positive. Within the dataset, 61 children were reported to CPS, with emotional neglect as the most frequent type of abuse (32.8%). The positive predictive value (PPV) of the checklist for child abuse was 8.3 (95% CI 3.9-15.2). The negative predictive value (NPV) was 99.1 (98.8-99.3), with 52 false negatives. When the length of the checklist was reduced to two questions closely related to the medical process (SPUTOVAMO-R3), the PPV was 9.1 (3.7-17.8) and the NPV 99.1 (98.7-99.3). These two questions are on the injury in relation to the history, and the interaction between child and parents.

Conclusions: The checklist SPUTOVAMO-R2 has a low detection rate of child abuse within the OPC setting, and a high false positive rate. Therefore, we recommend to use the shortened checklist only as a tool to increase the awareness of child abuse and not as a diagnostic instrument.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. SPUTOVAMO-R2 screening instrument for child abuse.
Reporting code: In the Netherlands, in case of a suspicion of child abuse, medical doctors are obligated to act according to the five steps of the reporting code for child abuse [17]. This reporting code ensures a thorough diagnostic process and careful communication with patient and family. With consistent use of the steps, a sound decision on whether to report to child protection services can be reached.
Fig 2
Fig 2. Flow diagram of screening for child abuse in the five Out-of-hours Primary Care locations.
Fig 3
Fig 3. Type of abuse (%) reported to CPS in 10 months follow up in 61 study cases versus type of abuse (%) reported to CPS in the Netherlands in the year 2013 (n = 33571).In 38 study cases there were multiple types of abuse reported.
Fig 4
Fig 4. Person reporting the child to CPS in 10 months follow up, in 61 cases.
Fig 5
Fig 5. Adapted checklist SPUTOVAMO-R3.
See this image and copyright information in PMC

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