title: Results of the implementation of a new screening protocol for child maltreatment at the Emergency Department of the Academic Medical Center in Amsterdam.
abstract: OBJECTIVE
  This study examines the results of the implementation of a new screening protocol for child maltreatment (CM) at the Emergency Department (ED) of the Academic Medical Center in Amsterdam, The Netherlands. This protocol consists of adding a so called 'top-toe' inspection (TTI), an inspection of the fully undressed child, to the screening checklist for child maltreatment, the SPUTOVAMO.
  
  
  METHODS
  We collected data from all patients 0-18 years old directly after introduction (February 2010) and 9 months later. Outcome measures were: completion of the screening and reasons for non-adherence. Data were collected on age, gender, reason for visiting the ED (defined by International Classification of Disease, ICD), presence of a chronic illness, type of professional performing the TTI and admission during week or weekend days.
  
  
  RESULTS
  In February 560 and in November 529 paediatric patients were admitted. In February the complete screening protocol was performed in 42% of all children, in November in 17%. A correlation between completion of the SPUTOVAMO and having a TTI performed was found. Older age and presence of a chronic illness influenced the chance of having both SPUTOVAMO and TTI performed negatively. The completion rate of SPUTOVAMO was influenced by ICD code. Completion of TTI was influenced by type of investigator. The best performing professional was the ED physician followed by the paediatrician followed by the ED nurse. The reasons for not performing a TTI were not documented. Refusal of the TTI by a patient or parent was reported three times.
  
  
  CONCLUSIONS
  Implementation of this new screening protocol for CM was only mildly successful and declined in time. A negative correlation between older child age and having a chronic illness and completion of the screening was found. A practical recommendation resulting from this study could be that, if CM screening protocols prove to be effective in detecting CM, regular training sessions have to be held. Filling out the checklist is something that could be performed by ED nurses. Performing a TTI is perhaps easier for the ED physicians to make part of their daily routine.
authors.affiliation: Department of Social Paediatrics, Emma Children's Hospital - Academic Medical Centre, Amsterdam, The Netherlands; Department of Paediatrics, Emma Children's Hospital - Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: a.h.teeuw@amc.nl.
authors.forename: Arianne H
authors.initials: AH
authors.lastname: Teeuw
authors.affiliation: Department of Social Paediatrics, Emma Children's Hospital - Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Tessa
authors.initials: T
authors.lastname: Sieswerda-Hoogendoorn
authors.affiliation: Medical Student, Faculty of Medicine, University of Amsterdam, The Netherlands.
authors.forename: Esmée J
authors.initials: EJ
authors.lastname: Sangers
authors.affiliation: Department of Paediatrics, Emma Children's Hospital - Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Hugo S A
authors.initials: HS
authors.lastname: Heymans
authors.affiliation: Department of Radiology, Emma Children's Hospital - Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Rick R
authors.initials: RR
authors.lastname: van Rijn
mesh_terms: D000046:Academic Medical Centers / Q000379:methods*; D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009426:Netherlands
keywords: Checklist; Child maltreatment; Emergency Department; Screening