Accuracy of a screening instrument to identify potential child abuse in emergency departments

Abstract

Although screening for child abuse at emergency departments (EDs) increases the detection rate of potential child abuse, an accurate instrument is lacking. This study was designed to measure the accuracy of a screening instrument for detection of potential child abuse used in EDs. In a prospective cohort study at three Dutch EDs, a 6-item screening instrument for child abuse, Escape, was completed for each child visiting the ED. The data from the completed Escape instrument was used to calculate sensitivity, specificity, and the positive/negative predictive value per item. The clinical notes and conclusions of the screen instruments of all potentially abused children reported to the hospitals' Child Abuse Teams were collected and reviewed by an expert panel. A logistic regression model was used to evaluate the predictors of potential abuse. Completed Escape instruments were available for 18,275 ED visits. Forty-four of the 420 children with a positive screening result, and 11 of the 17,855 children with a negative result were identified as potentially abused. Sensitivity of the Escape instrument was 0.80 and specificity was 0.98. Univariate logistic regression showed that potentially abused children were significantly more likely to have had an aberrant answer to at least one of the items, OR=189.8, 95% CI [97.3, 370.4]. Most of the children at high risk for child abuse were detected through screening. The Escape instrument is a useful tool for ED staff to support the identification of those at high risk for child abuse.

A screening protocol for child abuse at out-of-hours primary care locations: a descriptive study

“…With a low prevalence of positive checklists (0.2 %), one could argue about the cost-effectiveness ratio of mandatory use of a screening instrument. Other studies determined a prevalence of positive checklists of 1.6 to 2.6 %, with confirmation of child abuse in 3 to 69 % of those positive checklists [7, 10, 21, 22]. We do not have a valid explanation for the difference in prevalence of positive checklists at OOH-PC services (0.2 %) compared to the prevalence of positive checklists at emergency rooms (1.6–2.6 %).…”

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

“…A minimum sample of 4067 checklist negatives was calculated to be necessary, based on a sensitivity of 90% and a confidence level of 95% [8;13]. We estimated that around 4200 children are monthly seen at the five OPCs, resulting in an inclusion period of one month for all checklist negatives.…”

“…Screening instruments can assist physicians in recognizing child abuse at an early stage, thereby probably preventing any further harm [7;8]. Important places for recognizing child abuse are emergency rooms and Out-of-hours Primary Care locations (OPC) [9;10].…”

“…Sittig et al assessed the efficacy of detecting child abuse using the SPUTOVAMO-R at emergency rooms, and found low positive predictive values [13]. Louwers et al showed a moderate sensitivity and specificity of each question in their comparative screening instrument for child abuse, in a selected population (the screening instrument was not mandatory and consequently only filled in for 48% of the children) at emergency departments [8]. Evidently, the use of a screening instrument increases the awareness of child abuse [7].…”

“…child abuse present or absent) [7]. In addition, until now, no diagnostic value of screening instruments has been studied for all types of abuse in each child (unselected population) attending an emergency room or OPC [8;13–16]. For this study, we revised the SPUTOVAMO-R for emergency rooms into SPUTOVAMO-R2 for OPCs.…”