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An audit of emergency medicine responses to children injured in violence
Jonathan Shepherd1, David Tuthill, Bethan Parry
1Violence Research Group, Cardiff University, Cardiff, UK. shepherdjp@cardiff.ac.uk
Insights
Emergency departments rarely referred children injured by violence to child protection agencies. Most child violence incidents occurred in streets and schools, highlighting a need for improved referral policies.
Area of Science:
- Pediatric Emergency Medicine
- Child Protection
- Public Health
Background:
- Violence significantly impacts children's health and well-being.
- Emergency departments (EDs) are critical points for identifying and intervening in cases of child injury.
Purpose of the Study:
- To audit emergency department (ED) responses to child violence injuries in a European capital.
- To assess referral practices for children injured by violence.
Main Methods:
- Prospective survey of children (<16 years) treated in an ED.
- Review of clinical records for referrals to child protection agencies.
- Data collected using adapted ED software.
Main Results:
- 123 children injured by violence were treated; most were boys.
- Only 3% of incidents prompted documented referral or discussion with child protection agencies.
- 78% of cases received no action beyond injury treatment; most violence occurred in streets/schools.
Conclusions:
- ED treatment for child violence injuries infrequently led to referrals for child safety.
- Most child violence occurred outside the home (streets, schools).
- Policy development is needed for systematic disclosure of child violence cases to a central referral point.
Aim:
To audit emergency department (ED) responses to violence in which children are injured in violence in a European capital city.
Methods:
A prospective survey of children (aged <16 years) was conducted in Cardiff's only ED using ED software adapted for this purpose. All clinical records were scrutinised for evidence of discussion with and referral to agencies concerned with child protection.
Results:
123 children reportedly injured in violence (92 boys) were treated in 2004, six aged 5-9 years; one under 5 years. Overall, 24 (19%) incidents had been reported to the police prior to ED arrival. Only four (3%) prompted documented referral or discussions with other agencies while in the ED. 78% prompted no action apart from treatment of injuries. 13 (10%) children had fractures or were admitted, but only two of these incidents had been drawn to police attention. Only five (4%) were injured at home; a large majority were injured in the street or at school with fists or feet (12 with a weapon) by other children or adults.
Conclusions:
In this audit, most violence in which children were injured took place in schools and in the street. For children of secondary school age, ED treatment rarely prompted referral or discussion with agencies responsible for child safety. Particularly since youth and child violence are major national issues, policy and practice in this area were developed and built on disclosure of all such cases to a single referral point in the local authority education department.
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