title: Assessment and follow-up of suspected child abuse in preschool children with fractures seen in a general hospital emergency department.
abstract: OBJECTIVE
  To evaluate the emergency department assessment and follow-up of possible child abuse in children with fractures.
  
  
  METHODS
  A retrospective audit was conducted of children up to 3 years of age who presented with a fracture to a general hospital emergency department over a 2-year period.
  
  
  RESULTS
  In the 98 cases included, there was no documentation of complete physical examination in 57% of cases, whether the injury was witnessed in 54%, or time of injury in 18%. In 27% of cases the history documented was too brief to assess consistency of the injury with the history. Seventy-five per cent of children with known prior injuries did not have their past history documented. In 80% of all cases there was no indication that the emergency department doctor had considered the possibility of child abuse. Emergency doctors did not recognize four out of 16 cases (25%) with inconsistent histories. There was poor follow-up of patients in whom abuse was suspected: 46% of children less than 2 years had neither a skeletal survey nor bone scan. Patients referred to a paediatrician by the emergency department were significantly more likely to have a skeletal survey performed and to have the diagnosis of child abuse confirmed.
  
  
  CONCLUSIONS
  Emergency department staff in a general hospital do not document or assess for all of the indicators of child abuse in a high-risk population and they do not document consideration of the diagnosis in the majority of cases. Emergency department staff need more training and more resources to allow for full assessment of child abuse. Suspected child abuse cases should be referred to a paediatrician to improve investigation and follow-up.
authors.affiliation: Sydney Children's Hospital, Randwick, New South Wales, Australia. zieglerd@sesahs.nsw.gov.au
authors.forename: David S
authors.initials: DS
authors.lastname: Ziegler
authors.forename: John
authors.initials: J
authors.lastname: Sammut
authors.forename: Anne C
authors.initials: AC
authors.lastname: Piper
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D004282:Documentation; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D008485:Medical Audit; D009517:New South Wales / Q000453:epidemiology; D012189:Retrospective Studies