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Abstract
Aims: To evaluate how often children seen in paediatric accident & emergency (A&E) departments were suspected of abuse or neglect, and to explore some of the correlates of suspected child maltreatment.
Methods: Multicentre, cross-sectional study of 15 randomised census days during a six month period. Trained research assistants working with local paediatric staff completed a purpose made anonymised checklist covering sociodemographic and medical information. A six point suspicion index was used to rate compatibility with child maltreatment based on the occurrence of observable harm. Statistical analysis was carried out on the basis that a score of 4 or more was suspicious of child maltreatment. Nineteen hospitals provided standardised paediatric A&E consultation data on 0–14 year olds presenting between 10 am and 10 pm.
Results: Of 10 175 assessed children, 204 aroused suspicion of child maltreatment (95% CI 163 to 214 per 10 000). In a logistic regression model of suspected maltreatment statistically significant associations were found with socioeconomic disadvantage, children living in single parent families, and developmental delay. There was no correlation with pre-school age, male gender, foreign origin, or living in urban areas.
Conclusions: Child maltreatment based on immediate scoring of suspicion, focused on observable harm, occurred in 2% of a representative sample of paediatric emergency consultations in Italy. This was more common if there were associated social and developmental vulnerabilities. True prevalence of child maltreatment in emergency departments remains elusive because of changing definitions and forensic validation problems.
- child maltreatment
- suspicion index
- developmental delay
- epidemiology
- emergency departments
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Footnotes
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The study was funded by the Italian NIH in the framework of the National Mental Health Project
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Competing interests: none declared
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The IChilMa (Italian Child Maltreatment study group) included, in alphabetical order by city: D Besana, S Susigan (Azienda Ospedaliera Santi Antonio Biagio e Cesare Arrigo, Alessandria); G Cardoni, L Palma (Ospedale Pediatrico Salesi, Ancona); P Maremonti, D Intrano (Ospedale Giovanni XXIII, Bari); GP Salvioli, R Alessandroni, S Galletti (Pediatric Clinic, University of Bologna); C Pintor, M Concas (Pediatric Clinic, University of Cagliari); O Ciccone, L Cresta, F Gargiulo (Ospedale Gaslini, Genoa); V Carnelli, G Rollandi (Pediatric Clinic “G De Marchi”, University of Milan); G Chiumello, A Flores D’Arcais, I Coppa (Pediatric Clinic, Ospedale S Raffaele, Milan); G Rondanini, M Pirrotta, (Ospedale di Vimercate, Milan); E Caffo, S Bernasconi, S Madeo (Child Neuropsychiatry Institute and Pediatric Clinic, University of Modena and Reggio Emilia); M Berni Canani, N Aragione (Ospedale Santobono, Napoli); P Siani, C Miniero (Ospedale Cardarelli, Napoli); G Bona, R Osello, (Pediatric Clinic, University of Piemonte Orientale “A Avogadro”, Novara); P Facchin, S Manea (Pediatric Clinic, University of Padua); M Castello, E Properzi, R Guidi, F Mizzoni (Pediatric Clinic, University “La Sapienza”, Rome); G Viviano, A Musolino, M Marano, M Mattina (Ospedale Bambin Gesù, Rome); V Vecchi, F Nardocci, L Pausini, S Nucci (Department of Paediatrics, Ospedale degli Infermi, and Servizio di Neuropsichiatria Infantile, ASL di Rimini); GB Ferri, E Bordone (Azienda Ospedaliera “OIRM” S Anna, Ospedale Infantile R Margherita, Turin); A G Marchi, E Barth (IRCCS Burlo Garofolo, Trieste)