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Observational study of suspected maltreatment in Italian paediatric emergency departments
S Palazzi1, G de Girolamo, T Liverani
1Michael Rutter Centre for Children and Adolescents, Maudsley Hospital, London, UK. sp651@columbia.edu
Insights
Child maltreatment suspicion occurred in 2% of pediatric emergency visits. Socioeconomic disadvantage and developmental delays were associated with higher suspicion rates in children presenting to accident and emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Child Maltreatment Research
- Public Health
Background:
- Child maltreatment is a significant public health concern.
- Accurate identification of suspected child abuse and neglect in emergency settings is crucial.
- Understanding correlates of suspected maltreatment can inform prevention strategies.
Purpose of the Study:
- To determine the frequency of suspected child abuse or neglect among children attending pediatric accident and emergency (A&E) departments.
- To identify factors associated with suspected child maltreatment in this population.
Main Methods:
- A multicenter, cross-sectional study was conducted over six months.
- Trained research assistants collected anonymized data using a standardized checklist.
- A six-point suspicion index, focusing on observable harm, was used to identify cases suspicious of maltreatment (score ≥ 4).
Main Results:
- Of 10,175 assessed children, 204 (approximately 2%) aroused suspicion of child maltreatment.
- Logistic regression revealed significant associations between suspected maltreatment and socioeconomic disadvantage, single-parent families, and developmental delay.
- No correlation was found with preschool age, male gender, foreign origin, or urban residence.
Conclusions:
- Immediate suspicion scoring for child maltreatment in pediatric emergency consultations identified a prevalence of approximately 2%.
- Social and developmental vulnerabilities were associated with a higher likelihood of suspected maltreatment.
- The true prevalence of child maltreatment in emergency departments remains challenging to ascertain due to evolving definitions and forensic validation issues.
Aims:
To evaluate how often children seen in paediatric accident & emergency (A&E) departments were suspected of abuse or neglect, and to explore some of the correlates of suspected child maltreatment.
Methods:
Multicentre, cross-sectional study of 15 randomised census days during a six month period. Trained research assistants working with local paediatric staff completed a purpose made anonymised checklist covering sociodemographic and medical information. A six point suspicion index was used to rate compatibility with child maltreatment based on the occurrence of observable harm. Statistical analysis was carried out on the basis that a score of 4 or more was suspicious of child maltreatment. Nineteen hospitals provided standardised paediatric A&E consultation data on 0-14 year olds presenting between 10 am and 10 pm.
Results:
Of 10 175 assessed children, 204 aroused suspicion of child maltreatment (95% CI 163 to 214 per 10,000). In a logistic regression model of suspected maltreatment statistically significant associations were found with socioeconomic disadvantage, children living in single parent families, and developmental delay. There was no correlation with pre-school age, male gender, foreign origin, or living in urban areas.
Conclusions:
Child maltreatment based on immediate scoring of suspicion, focused on observable harm, occurred in 2% of a representative sample of paediatric emergency consultations in Italy. This was more common if there were associated social and developmental vulnerabilities. True prevalence of child maltreatment in emergency departments remains elusive because of changing definitions and forensic validation problems.
