title: Parents' Opinion About a Routine Head-to-Toe Examination of Children as a Screening Instrument for Child Abuse and Neglect in Children Visiting the Emergency Department.
abstract: BACKGROUND
  To improve detection of child abuse and neglect (CAN), many emergency departments use screening methods. Apart from diagnostic accuracy, possible harms of screening methods are important to consider, especially because most children are not abused and do not benefit from screening. We performed a systematic literature review to assess parents' opinions about CAN screening, in which we could only include 7 studies, all reporting that the large majority of participating parents favor screening. Recently, a complete physical examination (called "top-toe" inspection [TTI], a fully undressed inspection of the child) was implemented as a CAN screening method at the emergency department of a teaching hospital in The Netherlands. This study describes parents' opinions about the TTI.
  
  
  METHODS
  We used a questionnaire to assess parents' opinions about the TTI of their children when visiting the emergency department. During the study period, 1000 questionnaires were distributed by mail.
  
  
  RESULTS
  In total, 372 questionnaires were returned (37%). A TTI was performed for 194 children (52%). The overall attitude of parents whose children underwent a TTI was positive; 77.3% of the respondents found the TTI acceptable, and 1.5% (N = 3) found it unacceptable. Seventy percent of the respondents agreed with the theorem that all children who visit the emergency department should have a TTI performed, and 7.3% (N = 14) disagreed.
  
  
  CONCLUSIONS
  Contrary to what is commonly believed, both in our systematic literature review and in our questionnaire study, the majority of participating parents agree with screening for CAN in general and with the TTI specifically. Sharing the results of this study with ED personnel and policy makers could take away prejudices about perceived disagreement of parents, thereby improving implementation of and adherence to CAN screening.
authors.affiliation: Amsterdam, The Netherlands. Electronic address: A.H.Teeuw@amc.nl.
authors.forename: Arianne Hélène
authors.initials: AH
authors.lastname: Teeuw
authors.affiliation: Amsterdam, The Netherlands.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Hoytema van Konijnenburg
authors.affiliation: Amsterdam, The Netherlands.
authors.forename: Tessa
authors.initials: T
authors.lastname: Sieswerda-Hoogendoorn
authors.affiliation: Amsterdam, The Netherlands.
authors.forename: Sjaak
authors.initials: S
authors.lastname: Molenaar
authors.affiliation: Amsterdam, The Netherlands.
authors.forename: Hugo S
authors.initials: HS
authors.lastname: Heymans
authors.affiliation: Amsterdam, The Netherlands.
authors.forename: Rick R
authors.initials: RR
authors.lastname: van Rijn
mesh_terms: D001294:Attitude to Health; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D009426:Netherlands; D010290:Parents / Q000523:psychology*; D010808:Physical Examination / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Child abuse; Emergency department; Patient satisfaction; Physical examination; Screening