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

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dc.contributor.authorSittig, J. S., Uiterwaal, C. S., Moons, K. G., Russel, I. M., Nievelstein, R. A., Nieuwenhuis, E. E., & van de Putte, E. M.
dc.date.accessioned2016-07-22T18:26:37Z
dc.date.available2016-07-22T18:26:37Z
dc.date.issued2016
dc.description.abstractThe 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.identifier.citationSittig, 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.urihttp://bmjopen.bmj.com/content/6/3/e010788.full
dc.identifier.urihttp://hdl.handle.net/11212/2848
dc.language.isoenen_US
dc.publisherBMJ openen_US
dc.subjectchild abuseen_US
dc.subjectphysical abuseen_US
dc.subjectdiagnosisen_US
dc.subjectmedical evaluationen_US
dc.subjectpediatriciansen_US
dc.subjectInternational Resourcesen_US
dc.subjectNetherlandsen_US
dc.subjectresearchen_US
dc.titleValue of systematic detection of physical child abuse at emergency rooms: A cross-sectional diagnostic accuracy studyen_US
dc.typeArticleen_US

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