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Effects of systematic screening and detection of child abuse in emergency departments
Eveline C F M Louwers1, Ida J Korfage, Marjo J Affourtit
1Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.
Insights
Systematic screening for child abuse in emergency departments significantly increases detection rates. Training nurses and legal requirements are crucial for effective child abuse identification in pediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse Detection
- Public Health Interventions
Background:
- Limited evidence exists on the effectiveness of systematic child abuse screening in emergency departments.
- Emergency departments are critical points for identifying child abuse cases.
Purpose of the Study:
- To evaluate the impact of introducing a screening tool and nurse training on child abuse detection rates in emergency departments.
- To assess the effectiveness of an intervention aimed at improving child abuse identification.
Main Methods:
- An intervention cohort study involving 104,028 children (0-18 years) across 7 hospitals.
- Implementation of a screening checklist (the "Escape Form") and nurse training using an interrupted time-series design.
- Expert panel review for case determination and statistical analysis of screening and detection rates.
Main Results:
- The screening rate for child abuse increased from 20% to 67% during the study period.
- The detection rate of child abuse was 5 times higher in screened children compared to unscreened children (0.5% vs 0.1%).
- Significant increases in screening rates were associated with nurse training and legal mandates.
Conclusions:
- Systematic child abuse screening in emergency departments is effective in enhancing the detection of suspected cases.
- Both mandatory screening policies and comprehensive staff training are recommended to optimize child abuse detection.
- Interventions in emergency settings can significantly improve the identification of child abuse.
Objective:
Although systematic screening for child abuse of children presenting at emergency departments might increase the detection rate, studies to support this are scarce. This study investigates whether introducing screening, and training of emergency department nurses, increases the detection rate of child abuse.
Methods:
In an intervention cohort study, children aged 0 to 18 years visiting the emergency departments of 7 hospitals between February 2008 and December 2009 were enrolled. We developed a screening checklist for child abuse (the "Escape Form") and training sessions for nurses; these were implemented by using an interrupted time-series design. Cases of suspected child abuse were determined by an expert panel using predefined criteria. The effect of the interventions on the screening rate for child abuse was calculated by interrupted time-series analyses and by the odds ratios for detection of child abuse in screened children.
Results:
A total of 104028 children aged 18 years or younger were included. The screening rate increased from 20% in February 2008 to 67% in December 2009. Significant trend changes were observed after training the nurses and after the legal requirement of screening by the Dutch Health Care Inspectorate in 2009. The detection rate in children screened for child abuse was 5 times higher than that in children not screened (0.5% vs 0.1%, P < .001).
Conclusions:
These results indicate that systematic screening for child abuse in emergency departments is effective in increasing the detection of suspected child abuse. Both a legal requirement and staff training are recommended to significantly increase the extent of screening.
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