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The Child Protection Register: a tool in the accident and emergency department?
N M Flanagan1, C MacLeod, M G Jenkins
1Paediatrics, Antrim Area Hospital, Northern Ireland. nulesfl@hotmail.com
Insights
Most children on the Child Protection Register (CPR) attending accident and emergency (A&E) departments presented with common illnesses or trauma. Standard indicators for non-accidental injury (NAI) were adequate for detection when CPR status was unknown.
Area of Science:
- Pediatrics
- Forensic Medicine
- Public Health
Background:
- Children on the Child Protection Register (CPR) may access healthcare services, including accident and emergency (A&E) departments.
- Understanding the patterns of A&E attendance for these children is crucial for child protection.
- Assessing whether knowledge of CPR status influences the suspicion of non-accidental injury (NAI) is important for timely intervention.
Purpose of the Study:
- To quantify the number of children on the CPR attending A&E.
- To analyze referral sources, diagnostic categories, and attendance frequency.
- To evaluate if unawareness of CPR status hinders NAI suspicion when standard indicators are present.
Main Methods:
- Retrospective review of A&E records for children on the CPR.
- Data collected from June 1994 to May 2000 at the United Hospitals Trust.
- Analysis of attendance frequency, referral sources, and diagnoses.
Main Results:
- 191 children were on the CPR over six years; 79 attended A&E on 206 occasions.
- Self-referral was the most common source (81%), followed by GPs (13%).
- Trauma (limb, head injury) was common, with NAI not suspected in most cases; standard indicators were adequate for NAI detection when CPR status was unknown.
Conclusions:
- Screening for standard NAI indicators is sufficient for detecting most NAI cases in A&E, even without knowledge of CPR status.
- The majority of attendances were for non-abusive reasons.
- Further investigation into why concerns were not raised in all potential cases is warranted.
Aims:
To determine the number of children on the Child Protection Register (CPR) attending the accident and emergency (A&E) department and the referral source, diagnostic category, and frequency distribution for such attendances. To determine whether lack of knowledge that a child is on the CPR results in failure to suspect non-accidental injury (NAI) if the standard indicators of NAI have been sought.
Methods:
Access to the CPR was obtained. Records of each child attending the A&E departments of the United Hospitals Trust between June 1994 and May 2000 were reviewed.
Results:
Over the six years 191 children were on the CPR. Seventy nine (41%) attended A&E departments on 206 occasions. Frequency of attendance ranged to 18 with a mean of 2.6. Self referral was the commonest source of referral (81%) followed by general practitioners (13%), 999 calls (5%), and a small number from schools (1%). Most presentations involved trauma-upper limb (21%), lower limb (14%), and head injury (8%). Almost all cases of trauma were adjudged to be consistent with the history and NAI not suspected. Common childhood illnesses accounted for the remainder of presentations. Only six children were identified as being on the CPR at the time of presentation. Concerns were raised in two other cases and concerns should have been raised in three other children. Social Services were alerted on five occasions directly by the parents themselves.
Conclusions:
It is concluded that in the absence of knowledge of the status of a child on the CPR attending the A&E department, that screening for the standard indicators of NAI is adequate to detect most cases of NAI.