Child abuse inventory at emergency rooms: CHAIN-ER rationale and design
Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
BMC pediatrics
Abstract
Background: Child abuse and neglect is an important international health problem with unacceptable levels of
morbidity and mortality. Although maltreatment as a cause of injury is estimated to be only 1% or less of the
injured children attending the emergency room, the consequences of both missed child abuse cases and wrong
suspicions are substantial. Therefore, the accuracy of ongoing detection at emergency rooms by health care
professionals is highly important. Internationally, several diagnostic instruments or strategies for child abuse
detection are used at emergency rooms, but their diagnostic value is still unknown. The aim of the study ‘Child
Abuse Inventory at Emergency Rooms’ (CHAIN-ER) is to assess if active structured inquiry by emergency room staff
can accurately detect physical maltreatment in children presenting at emergency rooms with physical injury.
Methods/design: CHAIN-ER is a multi-centre, cross-sectional study with 6 months diagnostic follow-up. Five
thousand children aged 0-7 presenting with injury at an emergency room will be included. The index test - the
SPUTOVAMO-R questionnaire- is to be tested for its diagnostic value against the decision of an expert panel. All
SPUTOVAMO-R positives and a 15% random sample of the SPUTOVAMO-R negatives will undergo the same
systematic diagnostic work up, which consists of an adequate history being taken by a pediatrician, inquiry with
other health care providers by structured questionnaires in order to obtain child abuse predictors, and by
additional follow-up information. Eventually, an expert panel (reference test) determines the true presence or
absence of child abuse.
Discussion: CHAIN-ER will determine both positive and negative predictive value of a child abuse detection
instrument used in the emergency room. We mention a benefit of the use of an expert panel and of the use of
complete data. Conducting a diagnostic accuracy study on a child abuse detection instrument is also accompanied
by scientific hurdles, such as the lack of an accepted reference standard and potential (non-) response.
Notwithstanding these scientific challenges, CHAIN-ER will provide accurate data on the predictive value of
SPUTOVAMO-R.
Description
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Article
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Keywords
child abuse, medical, diagnosis
Citation
Sittig, J., Uiterwaal, C., Moons, K., Nieuwenhuis, E., & van de Putte, E. (2011). Child abuse inventory at emergency rooms: CHAIN-ER rationale and design. BMC pediatrics, 11(1), 91.