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Emergency medicine

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G/TUES/EME1 PREDICTION OF PHYSICAL ABUSE IN ACCIDENT AND EMERGENCY DEPARTMENTS BASED ON AGE, TYPE OF INJURY AND REPEAT ATTENDANCE

J. Woodman1, M. Pitt1, D. Hodes1, B. Taylor1, R. Gilbert1.1Institute of Child Health, London, UK; 2Peninsula Technology Assessment Group, Exteter, UK; 3University College London Hospital, London, UK; 4Islington Primary Care Trust, London, UK

Introduction: Protocols used to promote the detection of physical abuse in Accident and Emergency departments state that children at high risk of physical abuse should be assessed by a paediatrician. Children considered to be at high risk are injured infants (under 2 years), particularly with fractures or head injury. RCPCH guidelines state that children who repeatedly attend A&E for injury are also at high risk. In practice, A&E staff see two or three injury attendances a year as potentially worrying.

Aims: We aimed to evaluate the effectiveness of protocols specifying young age, type of injury or repeated attendance for detecting physical abuse in A&E.

Methods: We did a series of systematic reviews of studies reporting the characteristics of abused and accidentally injured children attending A&E.

Results: We scanned 7400 abstracts, retrieved 50 papers and included over 20 unique studies in the reviews. Few studies were based on all injured children attending A&E. Most related to more seriously injured children admitted to hospital from A&E. The one study (from Honolulu) that directly compared abused and non-abused children attending A&E provided no evidence that infants and preschool children were at increased risk of abuse. Indirect comparison of studies that measured attendance in either abused or non-abused children, but not both, provided weak evidence for an increased risk of physical abuse in injured infants. Studies of severely injured and admitted children showed a clinically important and statistically significant increased risk of abuse in the infant and preschool age groups, but were are not representative of …

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