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G308(P) Domestic violence and traumatic brain injury – are we asking the questions?
  1. J Fozard1,
  2. V Impey2,
  3. T Vince1
  1. 1Paediatric Intensive Care Unit, King’s College Hospital, London, UK
  2. 2London Deanery, London, UK

Abstract

Aim RCPCH Child Protection Companion states domestic violence (DV) is common and associated with physical abuse of children and neglect.1 DV has been identified as a risk factor for deaths in Serious Case Reviews. 2/3 serious case reviews where children are seriously harmed by abuse or neglect feature DV.1 NICE guidance on DV recommends routine enquiry (RE) and specific training for healthcare professionals when seeing children.2 A previous study in an adult-led ED found low levels of assessment of risk factors in fractures <3 years.3 We assessed the level of targeted enquiry about DV in children with traumatic brain injury (TBI) admitted to PICU in inner city location with high prevalence of DV.

Methods This multi-site study retrospectively audited PICU for the documentation of risk factors for child protection concerns and DV enquiry in children presenting with severe head injuries in all children admitted to the unit between September 2014–September 2015.

Conclusion Many of the mechanisms of TBI suggested no immediate, overt presenting concerns about child abuse, neglect, e.g road accidents. TBI presentations especially in children under 18 months need to be assessed for physical abuse and neglect. However, we found a lower than expected rate of enquiry about risk factors for abuse and neglect compared to NICE recommendations for RE.2 Despite being strongly linked to physical abuse of children, DV enquiry was poorly documented. This study highlights the low rate of targeted enquiry about DV by paediatric doctors and the need for more training in both recognition of risk factors for child abuse and neglect and the effects of DV on children. This study indicates that without specific training and support and a policy of routine enquiry, DV is not asked about by doctors reviewing young children and infants with severe head injury as often as expected. Barriers to doctors asking about DV are well documented in the literature.4 We will explore options to increase training and assessment of risk factors for abuse and neglect in practice.

References

  1. Recommendation 6 Domestic violence and abuse: multi-agency working NICE guidelines [PH50] Published date: February 2014

  2. Brandon et al. DFE-RR226. New learning from Serious Case Reviews: a two year report for 2009–2011

  3. Fractures in children under three years presenting to A&E Presented to BAACH Annual Scientific Meeting, 2014 E. Payne, H. Murch, C. Woolley

  4. Kevin Hamberger, Mary Phelan: Domestic Violence Screening in Medical and Mental Health Care settings: Overcoming Barriers to Screening, Identifying, and Helping Partner Violence Victims’, 2006

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