[Insufficient detection of child abuse in the emergency department]

To determine whether there are any differences between children known to be maltreated and a control group, the goal being an earlier detection of maltreated children in the emergency department (ED).

Retrospective case control study.

Children in whom child abuse had been ascertained by the Dutch child protection services (Advies- en Meldpunt Kindermishandeling, AMK) in Friesland in 2008, were compared with matched control children from Leeuwarden Medical Centre. For each child we established the total number of ED visits and the number of hospitals visited in Friesland in the 3 years prior to registration at the AMK. For each ED visit we recorded the reason for the visit, type of injury, if applicable, length of delay before seeking medical attention, diagnosis, reason for admission, completeness of the screening questionnaire and registration, if applicable, at the AMK. For each ED visit we assessed in retrospect whether there was a possibility of child abuse, whereby assessors were not aware of the group each child was in.

In the group of maltreated children, 93 of the 676 children collectively visited the ED 129 times, compared with 61 of 676 children in the control group who visited 69 times (odds ratio (OR):1.61; 95% CI: 1.14-2.27). 24 (26%) of the maltreated children who visited the ED went more than once; in the control group 6 children visited the ED more than once (9.8%) (OR: 3.19; 95% CI: 1.22-8.35). In retrospect the researchers suspected 11 cases of child abuse in the group of maltreated children but not one in the control group. These results were all significantly different between both groups, the other variables showed no significant difference. For 3 of the 93 maltreated children (3%) contact had been made with the AMK at the time of the most recent ED visit.

Children who were maltreated visited the ED more frequently and were more likely to visit the ED several times over a period of 3 years. Child abuse was not sufficiently detected in the ED.