Objective to validate a 6 item screening tool (the ESCAPE instrument), to improve screening by training of ED nurses and to evaluate detection of child abuse.

Methods Based on a systematic review the ESCAPE screening tool was developed. The validity was evaluated in the Netherlands in 18,275 children. Communication training sessions of the ED nurses were implemented and the effect on the screening and detection rate was evaluated.

Results The predictive value of the six screening items (e.g. consistent history, delay in seeking medical help, injury fits with developmental level, interaction, top-toe exam, doubt about safety) was high (sensitivity 0.80, specificity 0.98). The detection rate in children screened for child abuse was 5 times higher than that in children not screened. In the study population of 104.028 children (7 ED’s), the screening rate increased after introduction of the ESCAPE instrument from 20% to 67%. Significant trend changes were observed after training of the nurses and legal requirements for screening. The suspicion of child abuse detected by screening were justified in the majority.

Conclusions Systematic screening for child abuse in emergency departments is effective. The ESCAPE instrument and ED staff training are recommended to improve screening and detection rate of child abuse.