Implementation of the Dutch expertise centre for child abuse: descriptive data from the first 4 years
Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Open
Abstract
Objective Combined paediatric and forensic medical
expertise to interpret physical findings is not available in
Dutch healthcare facilities. The Dutch Expertise Centre
for Child Abuse (DECCA) was founded in the conviction
that this combination is essential in assessing potential
physical child abuse. DECCA is a collaboration between
the three paediatric hospitals and the Netherlands Forensic
Institute. DECCA works with Bayes’ theorem and uses
likelihood ratios in their conclusions.
Design We present the implementation process of DECCA
and cross-sectional data of the first 4 years.
Participants Between 14 December 2014 and 31
December 2018, a total of 761 advisory requests were
referred, all of which were included in this study. An
advisee evaluation over the year 2015 was performed
using a self-constructed survey to gain insight in the first
experiences with DECCA.
Results 761 cases were included, 381 (50.1%) boys
and 361 (47.4%) girls (19 cases (2.5%) sex undisclosed).
Median age was 1.5 years (range 1 day to 20 years).
Paediatricians (53.1%) and child safeguarding doctors
(21.9%) most frequently contacted DECCA. The two most
common reasons for referral were presence of injury/
skin lesions (n=592) and clinical history inconsistent
with findings (n=145). The most common injuries were
bruises (264) and non-skull fractures (166). Outcome of
DECCA evaluation was almost certainly no or improbable
child abuse in 35.7%; child abuse likely or almost certain
in 24.3%, and unclear in 12%. The advisee evaluations
(response rate 50%) showed that 93% experienced added
value and that 100% were (very) satisfied with the advice.
Conclusion Data show growing interest in the expertise
of DECCA through the years. DECCA seems to be a
valuable addition to Dutch child protection, since advisee
value the service and outcome of DECCA evaluations.
In almost half of the cases, DECCA concluded that child
abuse could not be substantiated.
Description
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Article
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Keywords
Netherlands, International Resources, clinical history, physical abuse, evaluation, medical examination, research
Citation
van Rijn, R. R., Affourtit, M. J., Karst, W. A., Kamphuis, M., de Bock, L. C., & van de Putte, E. (2019). Implementation of the Dutch expertise centre for child abuse: descriptive data from the first 4 years. BMJ open, 9(8), e031008.