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Value of systematic detection of physical child abuse at emergency rooms: A cross-sectional diagnostic accuracy study

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dc.contributor.author Sittig, J. S., Uiterwaal, C. S., Moons, K. G., Russel, I. M., Nievelstein, R. A., Nieuwenhuis, E. E., & van de Putte, E. M.
dc.date.accessioned 2016-07-22T18:26:37Z
dc.date.available 2016-07-22T18:26:37Z
dc.date.issued 2016
dc.identifier.citation Sittig, J. S., Uiterwaal, C. S., Moons, K. G., Russel, I. M., Nievelstein, R. A., Nieuwenhuis, E. E., & van de Putte, E. M. (2016). Value of systematic detection of physical child abuse at emergency rooms: A cross-sectional diagnostic accuracy study. BMJ open, 6(3), e010788. en_US
dc.identifier.uri http://bmjopen.bmj.com/content/6/3/e010788.full
dc.identifier.uri http://hdl.handle.net/11212/2848
dc.description.abstract The aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury. Design: A large multicentre study with a 6-month follow-up. Setting: 4 ERs in The Netherlands. Participants: 4290 children aged 0-7 years attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test). A national expert panel (reference standard) retrospectively assessed all children with positive screens and a 15% random sample of the children with negative screens for physical abuse, using additional information, namely, an injury history taken by a paediatrician, information provided by the general practitioner, youth doctor and social services by structured questionnaires, and 6-month follow-up information. Main Outcome Measure: Physical child abuse. Secondary Outcome Measure: Injury due to neglect and need for help. Results: 4253/4290 (99%) parents agreed to follow-up. At a prevalence of 0.07% (3/4253) for inflicted injury by expert panel decision, the positive predictive value of the checklist was 0.03 (95% CI 0.006 to 0.085), and the negative predictive value 1.0 (0.994 to 1.0). There was 100% (93 to 100) agreement about inflicted injury in children, with positive screens between the expert panel and child abuse experts. Conclusions: Rare cases of inflicted injury among preschool children presenting at ERs for injury are very likely captured by easy-to-use checklists, but at very high false-positive rates. Subsequent assessment by child abuse experts can be safely restricted to children with positive screens at very low risk of missing cases of inflicted injury. Because of the high false positive rate, we do advise careful prior consideration of cost-effectiveness and clinical and societal implications before de novo implementation. (Author Abstract) en_US
dc.language.iso en en_US
dc.publisher BMJ open en_US
dc.subject child abuse en_US
dc.subject physical abuse en_US
dc.subject diagnosis en_US
dc.subject medical evaluation en_US
dc.subject pediatricians en_US
dc.subject International Resources en_US
dc.subject Netherlands en_US
dc.subject research en_US
dc.title Value of systematic detection of physical child abuse at emergency rooms: A cross-sectional diagnostic accuracy study en_US
dc.type Article en_US


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