Table 1

Overview of articles included in this paper

ArticlePatientsDuration of study follow-upCountryAim of studyType of researchIntervention implemented during studyDetection rate before and after interventionConclusion of studyEffective screening method according to reviewers*
Pless et al. Child Abuse Negl130–5 years Trauma n=44224.5 monthsCanadaTo test the hypothesis that a more systematic evaluation of all children with accidents would increase the number of patients referred to the CPT because of suspected maltreatment and thereby result in an increased number of subsequently confirmed casesProspectiveIntroduction of the Accident-SCAN, a checklist with 10 questions for assessing the risk of child abuse, filled in by nurses who received special training. In combination with findings of the physician at physical examinationIncrease of confirmed cases of abuse and neglect 0.86% → 1.13% OR 1.32 95% CI 0.72 to 2.40No significant increase in detection of abuse after introduction of the SCAN. Authors concluded that ED staff were already doing well or the SCAN was not sufficientNot effective. Increase in confirmed cases of abuse was not significant
Sidebotham and Pearce. BMJ210–18 years All presenting symptoms n=2345Two audits of 2 months eachUnited KingdomTo show whether procedures for identifying children thought to be at risk of abuse were being followedProspectiveEducation and training of ED staff, introducing feedback, and updating the checklist, consisting of five risk factors for child abuseIncrease of children with ≥2 indicators discussed with the on-call paediatric registrar 0.22% → 1.32% OR 6.0 95% CI 1.71 to 21.2Procedures were being followed. Checklist heightens awareness of those children in whom there are features that might cause concernEffectiveness not shown. A significant increase of suspected abuse, but number of confirmed cases were not reported
Benger and Pearce. BMJ90–5 years Trauma n=2000Two audits of 3 months eachUnited KingdomTo improve child protection procedures by increasing the frequency with which intentional injury was adequately documented and considered by physicians. To increase the number of children referred for further assessment, thereby increasing the detection of child abuseProspectiveIntroduction of a flowchart, with four questions, in the patient's file for assessing child abuse and consulting the CPRIncrease of cases of suspected abuse referred to social services after 6 months. The outcome of referred children could not be determined 0.6% → 1.4% OR 2.33 95% CI 0.89 to 6.1Inclusion of a flowchart increased awareness, consideration and documentation of suspected abuseEffectiveness not shown. A non-significant increase of suspected abuse, and authors could not establish number of confirmed cases
Bleeker et al. Ned Tijdschr Geneeskd140–17 years Suspected cases of abuse at all departments n=22040 monthsThe NetherlandsTo describe characteristics of child abuse, establish directives in cases of suspected abuse and introduction of a checklistRetrospectiveEvaluation and analysis of collected information on child abuse, introduction of a checklist consisting of nine questionsAfter intervention 28 cases of confirmed abuse were detected at the EDIncrease of detected cases of confirmed abuse after introduction of a checklist at the ED and analysis by expertsEffectiveness not shown. No registration of situation before introduction of the intervention
  • * Effective screening method: due to the intervention, the rate of cases of confi rmed child abuse increased signifi cantly.

  • CPR, Child Protection Register; CPT, Child Protection Team; ED, emergency department; SCAN, Suspected Child Abuse and Neglect.