title: Effects of systematic screening and detection of child abuse in emergency departments.
abstract: OBJECTIVE
  Although systematic screening for child abuse of children presenting at emergency departments might increase the detection rate, studies to support this are scarce. This study investigates whether introducing screening, and training of emergency department nurses, increases the detection rate of child abuse.
  
  
  METHODS
  In an intervention cohort study, children aged 0 to 18 years visiting the emergency departments of 7 hospitals between February 2008 and December 2009 were enrolled. We developed a screening checklist for child abuse (the "Escape Form") and training sessions for nurses; these were implemented by using an interrupted time-series design. Cases of suspected child abuse were determined by an expert panel using predefined criteria. The effect of the interventions on the screening rate for child abuse was calculated by interrupted time-series analyses and by the odds ratios for detection of child abuse in screened children.
  
  
  RESULTS
  A total of 104028 children aged 18 years or younger were included. The screening rate increased from 20% in February 2008 to 67% in December 2009. Significant trend changes were observed after training the nurses and after the legal requirement of screening by the Dutch Health Care Inspectorate in 2009. The detection rate in children screened for child abuse was 5 times higher than that in children not screened (0.5% vs 0.1%, P < .001).
  
  
  CONCLUSIONS
  These results indicate that systematic screening for child abuse in emergency departments is effective in increasing the detection of suspected child abuse. Both a legal requirement and staff training are recommended to significantly increase the extent of screening.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.
authors.forename: Eveline C F M
authors.initials: EC
authors.lastname: Louwers
authors.forename: Ida J
authors.initials: IJ
authors.lastname: Korfage
authors.forename: Marjo J
authors.initials: MJ
authors.lastname: Affourtit
authors.forename: Dop J H
authors.initials: DJ
authors.lastname: Scheewe
authors.forename: Marjolijn H
authors.initials: MH
authors.lastname: van de Merwe
authors.forename: Anne-Françoise S R
authors.initials: AF
authors.lastname: Vooijs-Moulaert
authors.forename: Annette P M
authors.initials: AP
authors.lastname: van den Elzen
authors.forename: Mieke H T M
authors.initials: MH
authors.lastname: Jongejan
authors.forename: Madelon
authors.initials: M
authors.lastname: Ruige
authors.forename: Badies H A N
authors.initials: BH
authors.lastname: Manaï
authors.forename: Caspar W N
authors.initials: CW
authors.lastname: Looman
authors.forename: Adriaan N
authors.initials: AN
authors.lastname: Bosschaart
authors.forename: Arianne H
authors.initials: AH
authors.lastname: Teeuw
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
mesh_terms: D000293:Adolescent; D057189:Checklist; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D016529:Emergency Nursing / Q000193:education; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009426:Netherlands