Child abuse inventory at emergency rooms: CHAIN-ER rationale and design

Abstract

BackgroundChild abuse and neglect is an important international health problem with unacceptable levels of morbidity and mortality. Although maltreatment as a cause of injury is estimated to be only 1% or less of the injured children attending the emergency room, the consequences of both missed child abuse cases and wrong suspicions are substantial. Therefore, the accuracy of ongoing detection at emergency rooms by health care professionals is highly important. Internationally, several diagnostic instruments or strategies for child abuse detection are used at emergency rooms, but their diagnostic value is still unknown. The aim of the study 'Child Abuse Inventory at Emergency Rooms' (CHAIN-ER) is to assess if active structured inquiry by emergency room staff can accurately detect physical maltreatment in children presenting at emergency rooms with physical injury.Methods/designCHAIN-ER is a multi-centre, cross-sectional study with 6 months diagnostic follow-up. Five thousand children aged 0-7 presenting with injury at an emergency room will be included. The index test - the SPUTOVAMO-R questionnaire- is to be tested for its diagnostic value against the decision of an expert panel. All SPUTOVAMO-R positives and a 15% random sample of the SPUTOVAMO-R negatives will undergo the same systematic diagnostic work up, which consists of an adequate history being taken by a pediatrician, inquiry with other health care providers by structured questionnaires in order to obtain child abuse predictors, and by additional follow-up information. Eventually, an expert panel (reference test) determines the true presence or absence of child abuse.DiscussionCHAIN-ER will determine both positive and negative predictive value of a child abuse detection instrument used in the emergency room. We mention a benefit of the use of an expert panel and of the use of complete data. Conducting a diagnostic accuracy study on a child abuse detection instrument is also accompanied by scientific hurdles, such as the lack of an accepted reference standard and potential (non-) response. Notwithstanding these scientific challenges, CHAIN-ER will provide accurate data on the predictive value of SPUTOVAMO-R.

Screening methods to detect child maltreatment: high variability in Dutch emergency departments

“…Of all the hospitals that provided checklists, 21 used a checklist that has been reported in the literature (27%). The SPUTOVAMO checklist17 18 was used in 12 hospitals (16%), the ESCAPE Form13 was used in 6 hospitals (8%) and the SPUTOVAMO-R checklist12 was used in 3 hospitals (4%) (see online supplementary appendices 2–4). The other 56 hospitals (73%) used modified versions of the above checklists or another checklist that has not been reported in the literature.…”

“…In total, 28 different items were identified in the screening checklists, of which 12 were not part of any of the four checklists reported in the literature (table 2). 12 13 17 19 Of these 28 items, 8 items (at least one item used in all emergency departments) were related to parental behaviour, 5 (at least one item used in 76 emergency departments) to an unclear history and 5 (at least one item used in 71 emergency departments) to characteristics of an injury.…”

“…The validity of the SPUTOVAMO and the SPUTOVAMO-R checklists has not yet been evaluated,20 21 although research to determine the diagnostic accuracy of both checklists is currently being performed (Teeuw, personal communication, 2013) 12. A recent study evaluating the effectiveness of the ESCAPE Form showed that screening was effective in increasing the detection rate of suspected child maltreatment as confirmed by an expert panel from 0.1% to 0.5% 13.…”

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

“…Important places for recognizing child abuse are emergency rooms and Out-of-hours Primary Care locations (OPC) [9;10]. A screening protocol with a screening instrument for child abuse at OPCs is mandatory in the Netherlands since 2011 [11].…”

“…One of the advised tools for screening is the SPUTOVAMO checklist. SPUTOVAMO, or the revised version SPUTOVAMO-R, is a screening instrument using various questions to determine whether there is a suspicion of child abuse [9;12]. Sittig et al assessed the efficacy of detecting child abuse using the SPUTOVAMO-R at emergency rooms, and found low positive predictive values [13].…”