title: Simple intervention to improve detection of child abuse in emergency departments.
abstract: OBJECTIVE
  Child abuse is easily overlooked in a busy emergency department.
  
  
  METHODS
  Two stage audit of 1000 children before and after introduction of reminder flowchart.
  
  
  METHODS
  An emergency department in a suburban teaching hospital seeing about 4000 injured preschool children a year.
  
  
  METHODS
  Number of records in which intentional injury was adequately documented and considered and the number of children referred for further assessment before and after introduction of reminder flowchart into emergency department notes.
  
  
  METHODS
  Nurses were asked to insert a reminder flowchart for assessing intentional injury into the notes of all children aged 0-5 years attending the department with any injury and to record the results of checking the child protection register. EFFECT OF CHANGE: Documentation of all eight indicators that intentional injury had been considered had increased in the second audit. Records of compatibility of history with injury and consistency of history increased from less than 2% to more than 70% (P<0.0001). More children were referred for further assessment in the second audit than the first, although the difference was not significant (6 (0.6%) v 14 (1.4%), P=0.072). The general level of awareness and vigilance increased in the second audit, even for children whose records did not contain the flowchart.
  
  
  CONCLUSIONS
  Inclusion of a simple reminder flowchart in the notes of injured preschool children attending the emergency department increases awareness, consideration, and documentation of intentional injury. Rates of referral for further assessment also increase.
authors.affiliation: Emergency Department, Frenchay Hospital, Bristol BS16 1LE.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Benger
authors.forename: V
authors.initials: V
authors.lastname: Pearce
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000592:standards*; D004739:England; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019221:Mandatory Reporting; D008485:Medical Audit; D017010:Reminder Systems; D012985:Software Design; D018881:Suburban Health; D014947:Wounds and Injuries / Q000175:diagnosis*