Several national bodies and government departments have stated that it is important that accident and emergency (A&E) department should have ready access to child protection registers. A survey of UK A&E departments (G Quin and R Evans. Emergency Medicine Journal2002;19:136–7) has shown considerable variation in the method of access, criteria for checking, and satisfaction with access to the register.

A postal questionnaire was sent to consultants in 254 major A&E departments and 190 questionnaires (75%) were returned. The most common way of accessing the child protection register (48% of departments) was via the duty social worker but this is time consuming and restricts the number of children who can be checked. One third of departments had access to a copy of the register, (computerised in half of them). Eighteen per cent of departments used combined means of access (social worker plus copy or social worker plus police) or other means. Satisfaction with the means of access was expressed by most consultants using computerised or hard copies of the register (82% and 66% respectively) but by only half of those using only the duty social worker or combined methods. Access to a copy of the register provided only local, and often out of date, information.

Thirty per cent of departments checked all children against the register and the rest either checked children with specified risk factors or relied on staff suspicion of child abuse. Departments with their own copy of the register tend to check all children but distributing copies could put confidentiality at risk. Registration is neither sensitive nor specific for current abuse (many children with nonaccidental injury will not be on the register and children on the register may have accidental injuries). On the other hand about 7% of children put on the register in 1982 were reinjured within a year.

Which policy is the best for the protection of children is not known. It is suggested that outcomes should be compared between departments using different methods.