Article | Patients | Duration of study follow-up | Country | Aim of study | Type of research | Intervention implemented during study | Detection rate before and after intervention | Conclusion of study | Effective screening method according to reviewers* |
---|---|---|---|---|---|---|---|---|---|
Pless et al. Child Abuse Negl13 | 0–5 years Trauma n=4422 | 4.5 months | Canada | To 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 cases | Prospective | Introduction 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 examination | Increase of confirmed cases of abuse and neglect 0.86% → 1.13% OR 1.32 95% CI 0.72 to 2.40 | No 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 sufficient | Not effective. Increase in confirmed cases of abuse was not significant |
Sidebotham and Pearce. BMJ21 | 0–18 years All presenting symptoms n=2345 | Two audits of 2 months each | United Kingdom | To show whether procedures for identifying children thought to be at risk of abuse were being followed | Prospective | Education and training of ED staff, introducing feedback, and updating the checklist, consisting of five risk factors for child abuse | Increase of children with ≥2 indicators discussed with the on-call paediatric registrar 0.22% → 1.32% OR 6.0 95% CI 1.71 to 21.2 | Procedures were being followed. Checklist heightens awareness of those children in whom there are features that might cause concern | Effectiveness not shown. A significant increase of suspected abuse, but number of confirmed cases were not reported |
Benger and Pearce. BMJ9 | 0–5 years Trauma n=2000 | Two audits of 3 months each | United Kingdom | To 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 abuse | Prospective | Introduction of a flowchart, with four questions, in the patient's file for assessing child abuse and consulting the CPR | Increase 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 6.1 | Inclusion of a flowchart increased awareness, consideration and documentation of suspected abuse | Effectiveness not shown. A non-significant increase of suspected abuse, and authors could not establish number of confirmed cases |
Bleeker et al. Ned Tijdschr Geneeskd14 | 0–17 years Suspected cases of abuse at all departments n=220 | 40 months | The Netherlands | To describe characteristics of child abuse, establish directives in cases of suspected abuse and introduction of a checklist | Retrospective | Evaluation and analysis of collected information on child abuse, introduction of a checklist consisting of nine questions | After intervention 28 cases of confirmed abuse were detected at the ED | Increase of detected cases of confirmed abuse after introduction of a checklist at the ED and analysis by experts | Effectiveness 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.