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Accuracy of a screening instrument to identify potential child abuse in emergency departments
Eveline C F M Louwers1, Ida J Korfage2, Marjo J Affourtit3
1Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
Insights
The Escape screening tool accurately identifies children at high risk for abuse in emergency departments (EDs). This validated instrument supports ED staff in detecting potential child abuse cases effectively.
Area of Science:
- Pediatrics
- Emergency Medicine
- Child Abuse Detection
Background:
- Emergency departments (EDs) are crucial for identifying potential child abuse.
- Existing screening instruments often lack sufficient accuracy.
- A validated tool is needed to improve child abuse detection rates in EDs.
Purpose of the Study:
- To measure the accuracy of the 6-item Escape screening instrument for child abuse detection.
- To evaluate the sensitivity, specificity, and predictive values of the Escape instrument in ED settings.
- To assess the instrument's utility for identifying children at high risk of abuse.
Main Methods:
- Prospective cohort study conducted at three Dutch emergency departments.
- The 6-item Escape screening instrument was administered to children visiting the ED.
- Data analysis included calculating sensitivity, specificity, and predictive values, with logistic regression for predictor evaluation.
Main Results:
- The Escape instrument was completed for 18,275 ED visits.
- Sensitivity was 0.80, and specificity was 0.98, indicating high accuracy.
- Children with positive screening results were significantly more likely to be identified as potentially abused (OR=189.8).
Conclusions:
- The Escape instrument demonstrates high accuracy in identifying children at high risk for abuse in EDs.
- The tool effectively supports emergency department staff in the detection of potential child abuse.
- The Escape instrument is a valuable addition to current child abuse screening protocols.
Abstract:
Although screening for child abuse at emergency departments (EDs) increases the detection rate of potential child abuse, an accurate instrument is lacking. This study was designed to measure the accuracy of a screening instrument for detection of potential child abuse used in EDs. In a prospective cohort study at three Dutch EDs, a 6-item screening instrument for child abuse, Escape, was completed for each child visiting the ED. The data from the completed Escape instrument was used to calculate sensitivity, specificity, and the positive/negative predictive value per item. The clinical notes and conclusions of the screen instruments of all potentially abused children reported to the hospitals' Child Abuse Teams were collected and reviewed by an expert panel. A logistic regression model was used to evaluate the predictors of potential abuse. Completed Escape instruments were available for 18,275 ED visits. Forty-four of the 420 children with a positive screening result, and 11 of the 17,855 children with a negative result were identified as potentially abused. Sensitivity of the Escape instrument was 0.80 and specificity was 0.98. Univariate logistic regression showed that potentially abused children were significantly more likely to have had an aberrant answer to at least one of the items, OR=189.8, 95% CI [97.3, 370.4]. Most of the children at high risk for child abuse were detected through screening. The Escape instrument is a useful tool for ED staff to support the identification of those at high risk for child abuse.
