Screening injured children for physical abuse or neglect in emergency departments: a systematic review

Abstract

There was no evidence that any of the markers (infancy, type of injury, repeated attendance) were sufficiently accurate (i.e. LR >or= 10) to screen injured children in the ED to identify those requiring paediatric assessment for possible physical abuse or neglect. Clinicians should be aware that among injured children at ED a high proportion of abused children will present without these characteristics and a high proportion of non-abused children will present with them. Information about age, injury type and repeat attendances should be interpreted in this context.

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

“…The positive predictive values of the different individual items on screening checklists for child maltreatment have been poorly studied 11 20 21. Woodman et al 11 reviewed the evidence for the association between several characteristics and physical child abuse in injured children at the emergency department.…”

“…Woodman et al 11 reviewed the evidence for the association between several characteristics and physical child abuse in injured children at the emergency department. They concluded that none of the characteristics (age, repeat (prior) attendance and type of injury) were accurate enough to detect child maltreatment 11. There were insufficient studies to review any other items such as severity of injury, delay in attendance and inconsistent history 11.…”

“…They concluded that none of the characteristics (age, repeat (prior) attendance and type of injury) were accurate enough to detect child maltreatment 11. There were insufficient studies to review any other items such as severity of injury, delay in attendance and inconsistent history 11. The authors state that the most effective screening items would be to refer all severely injured infants (injury in children aged <1 year) and all social work active children (child maltreatment (suspicion) in history).…”

Evaluation of Child Maltreatment in the Emergency Department Setting

“…20,21 Although observational studies suggest that these may be useful, none have been shown to be sufficiently accurate or reproducible. [22][23][24][25] A brief introspection of whether the child is being abused is often enough of a consideration, but there are several chief complaints that deserve further investigation. There are "Six B's" that have high potentials for abuse and should heighten ED suspicion: bruises, breaks, bonks (head injury), burns, bites, and baby blues (Box 2).…”

Injuries of Non-Lethal Child Physical Abuse to the Crania and Orofacial Regions: A Scientific Review

“…The detection of child maltreatment depends on clinicians' ability to recognize and diagnose suspicious lesions, conduct a complete physical examination, with judicious use of diagnostic exams, and consider whether the explanation given by caregivers is supported by the characteristics of the injury or injuries and developmental capabilities of the child [10,11]. It should also be taken into account how often the child is observed by trauma [12].…”