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Screening for child abuse at emergency departments: a systematic review
Eveline C F M Louwers1, Marjo J Affourtit, Henriette A Moll
1Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands. e.louwers@erasmusmc.nl
Insights
Child abuse detection in emergency departments is low. Interventions like risk checklists show promise by increasing suspected case detection, but evidence for confirmed abuse cases remains inconclusive.
Area of Science:
- Pediatrics
- Public Health
- Emergency Medicine
Background:
- Child abuse is a global issue with low detection rates in emergency departments.
- Emergency departments are critical points for identifying abused children.
Purpose of the Study:
- To find effective emergency department interventions for increasing confirmed child abuse detection.
- To evaluate strategies aimed at improving the identification of child abuse cases.
Main Methods:
- Systematic literature review following Cochrane Handbook guidelines.
- Searched major databases (PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL).
- Included studies describing interventions for child abuse detection in emergency settings.
Main Results:
- Four studies met quality criteria, focusing on risk checklists.
- Suspected child abuse detection increased by 180% with checklist interventions.
- No significant increase in confirmed child abuse cases was observed in most studies.
Conclusions:
- Literature on emergency department interventions for confirmed child abuse is limited.
- Current evidence is insufficient to conclusively prove intervention effectiveness.
- Further research with robust methodology is needed.
Introduction:
Child abuse is a serious problem worldwide and can be difficult to detect. Although children who experience the consequences of abuse will probably be treated at an emergency department, detection rates of child abuse at emergency departments remain low.
Objective:
To identify effective interventions applied at emergency departments that significantly increase the detection rate of confirmed cases of child abuse.
Design:
This review was carried out according to the Cochrane Handbook. Two reviewers individually searched PubMed, the Cochrane Library, EMBASE, Web of Science and CINAHL for papers that met the inclusion criteria.
Results:
Fifteen papers describing interventions were selected and reviewed; four of these were finally included and assessed for quality. In these studies the intervention consisted of a checklist of indicators of risk for child abuse. After implementation, the rate of detected cases of suspected child abuse increased by 180% (weighted mean in three studies). The number of confirmed cases of child abuse, reported in two out of four studies, showed no significant increase.
Conclusions:
Interventions at emergency departments to increase the detection rate of cases of confirmed child abuse are scarce in the literature. Past study numbers and methodology have been inadequate to show conclusive evidence on effectiveness.
