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Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study
OBJECTIVES: 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-mo...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809108/ https://www.ncbi.nlm.nih.gov/pubmed/27006346 http://dx.doi.org/10.1136/bmjopen-2015-010788 |
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author | Sittig, Judith S Uiterwaal, Cuno S P M Moons, Karel G M Russel, Ingrid M B Nievelstein, Rutger A J Nieuwenhuis, Edward E S van de Putte, Elise M |
author_facet | Sittig, Judith S Uiterwaal, Cuno S P M Moons, Karel G M Russel, Ingrid M B Nievelstein, Rutger A J Nieuwenhuis, Edward E S van de Putte, Elise M |
author_sort | Sittig, Judith S |
collection | PubMed |
description | OBJECTIVES: 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. |
format | Online Article Text |
id | pubmed-4809108 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-48091082016-04-01 Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study Sittig, Judith S Uiterwaal, Cuno S P M Moons, Karel G M Russel, Ingrid M B Nievelstein, Rutger A J Nieuwenhuis, Edward E S van de Putte, Elise M BMJ Open Paediatrics OBJECTIVES: 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. BMJ Publishing Group 2016-03-22 /pmc/articles/PMC4809108/ /pubmed/27006346 http://dx.doi.org/10.1136/bmjopen-2015-010788 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Paediatrics Sittig, Judith S Uiterwaal, Cuno S P M Moons, Karel G M Russel, Ingrid M B Nievelstein, Rutger A J Nieuwenhuis, Edward E S van de Putte, Elise M Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study |
title | Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study |
title_full | Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study |
title_fullStr | Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study |
title_full_unstemmed | Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study |
title_short | Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study |
title_sort | value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study |
topic | Paediatrics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809108/ https://www.ncbi.nlm.nih.gov/pubmed/27006346 http://dx.doi.org/10.1136/bmjopen-2015-010788 |
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