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Potential Child Abuse Screening in Emergency Department; a Diagnostic Accuracy Study
Hossein Dinpanah1, Abazar Akbarzadeh Pasha2
1Emergency Department, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran.
Insights
The Escape instrument effectively screens for child abuse risk in emergency departments, demonstrating high diagnostic accuracy. This tool aids in identifying children needing further evaluation for abuse, improving patient safety.
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse Detection
- Diagnostic Accuracy Studies
Background:
- Accurate identification of child abuse risk is crucial in emergency settings.
- The Escape instrument was developed to aid in this critical triage process.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the Escape instrument for identifying children at risk of abuse in the emergency department (ED).
Main Methods:
- A diagnostic accuracy study involving 6120 children under 16 years old presented to the ED over three years.
- The child abuse team's confirmation served as the gold standard for diagnosis.
- Screening performance characteristics were calculated using STATA 21.
Main Results:
- The study screened 6120 children, with 35 confirmed child abuse victims (0.5%).
- The Escape instrument demonstrated high sensitivity (100%) and specificity (98.3%).
- The Area Under the ROC Curve was 99.2%, indicating excellent diagnostic performance.
Conclusions:
- The Escape instrument appears to be a suitable screening tool for detecting child abuse risk in ED presentations.
- The study highlights the tool's excellent accuracy (99.2%) in identifying at-risk children.
Introduction:
Designing a tool that can differentiate those at risk of child abuse with great diagnostic accuracy is of great interest. The present study was designed to evaluate the diagnostic accuracy of Escape instrument in triage of at risk cases of child abuse presenting to emergency department (ED).
Method:
The present diagnostic accuracy study performed on 6120 of the children under 16 years old presented to ED during 3 years, using convenience sampling. Confirmation by the child abuse team (pediatrician, a social worker, and a forensic physician) was considered as the gold standard. Screening performance characteristics of Escape were calculated using STATA 21.
Results:
6120 children with the mean age of 2.19 ± 1.12 years were screened (52.7% girls). 137 children were suspected victims of child abuse. Based on child abuse team opinion, 35 (0.5%) children were confirmed victims of child abuse. Sensitivity, specificity, positive and negative likelihood ratio and positive and negative predictive values of this test with 95% CI were 100 (87.6 - 100), 98.3 (97.9 - 98.6), 25.5 (18.6 - 33.8), 100 (99.9 - 100), 0.34 (0.25 - 0.46), and 0 (0 - NAN), respectively. Area under the ROC curve was 99.2 (98.9 - 99.4).
Conclusion:
It seems that Escape is a suitable screening instrument for detection of at risk cases of child abuse presenting to ED. Based on the results of the present study, the accuracy of this screening tool is 99.2%, which is in the excellent range.
