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 …