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Screening for child abuse using a checklist and physical examinations in the emergency department led to the detection of more cases
Author(s) -
Teeuw Arianne H.,
Kraan Rik B. J.,
Rijn Rick R.,
Bossuyt Patrick M. M.,
Heymans Hugo S. A.
Publication year - 2019
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14495
Subject(s) - medicine , emergency department , checklist , child abuse , pediatric emergency medicine , medical diagnosis , pediatrics , false positive paradox , child behavior checklist , poison control , injury prevention , psychiatry , emergency medicine , family medicine , emergency physician , pathology , psychology , machine learning , computer science , cognitive psychology
Aim We studied the accuracy of a screening checklist ( SPUTOVAMO ), complete physical examination (top‐to‐toe inspection, TTI ) and their combination in detecting child abuse in the emergency department ( ED ). Methods Consecutive patients admitted to the ED of the Academic Medical Center in Amsterdam between January 2011 and 1 July 2013 were included. An Expert Panel assigned a consensus diagnosis to positive cases. For all other and missed cases, the Child Abuse Counselling and Reporting Centre diagnosis was used. Results We included 17 229 admissions of 12 198 patients. In 46%, SPUTOVAMO was performed, in 33% TTI ; 421 children (4.3%) tested positive on either or both, with 68 positive consensus diagnoses. In eight children not reported to the Expert Panel, the Child Abuse Counselling and Reporting Center diagnosis was positive. Ten of 3519 (0.3%) children testing negative on both were child abuse cases; 0.88% of the study group had a final child abuse diagnosis. The estimated PPV was 0.46 for SPUTOVAMO , 0.44 for TTI and 0.43 for the combination. Conclusion Combining screening tests significantly increased the number of test positives and led to more child abuse cases detected. Combined screening for child abuse in all children less than 18 years old presenting to an ED is recommended.