title: [Complementary exams in child abuse: A French national study in 2015].
abstract: BACKGROUND
  Even if there are HAS (French National Health Authority) guidelines on shaken baby syndrome, many other child abuse situations are not included in these recommendations. The aim of this study was to invent the complementary exams in cases of child abuse in France and compare the practice to existing guidelines.
  
  
  METHODS
  This was a multicenter study by email to 128 French hospitals (35 university hospitals and 93 general hospitals) that receives children in emergency and hospitalization settings. Three child abuse clinical situations were included in a clinical case multiple-choice format concerning the further explorations. We described the main results and evaluated their adherence to the HAS protocol for case 1.
  
  
  RESULTS
  Of 128 hospitals surveyed, 104 responded, for an 81 % response rate, which corresponded to 274 doctors. Analysis of the results showed great heterogeneity in practices. The majority of physicians (99 %) performed systematic explorations in the situation of physical abuse, while only 27 % undertook such exams in situations of serious neglect. The situation of sexual abuse was the most consensual in terms of diagnostic tests for the detection of sexually transmitted diseases, but other types of associated abuse were not sought. In the first case, the HAS guidelines were respected in less than half of the cases for all complementary exams except the eye fundus exam. Abdominal imaging was insufficiently performed (40 % of cases). Examinations that were not indicated were still prescribed. Moreover, siblings under 2 years of age were examined in only one-third of cases (n=88/274; 32 %). Practices were not influenced by the age of the child.
  
  
  CONCLUSIONS
  This study illustrates the heterogeneity in the use of complementary exams in cases of child abuse in France. Common protocols throughout the country would be useful, standardizing the most relevant exams for potential medical-legal issues, and facilitating exchanges concerning practices between different centers.
authors.affiliation: Service de spécialités pédiatriques et médecine infantile, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
authors.forename: A
authors.initials: A
authors.lastname: Ledoyen
authors.affiliation: Urgences pédiatriques, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
authors.forename: V
authors.initials: V
authors.lastname: Bresson
authors.affiliation: Service de spécialités pédiatriques et médecine infantile, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Service de médecine infantile, hôpital Nord, chemin des Bourrely, 13915 Marseille cedex 20, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Dubus
authors.affiliation: Pôle Santé publique, service d'évaluation médicale, CHU Conception, 147, boulevard Baille, 13005 Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Tardieu
authors.affiliation: Service de radiologie pédiatrique, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
authors.forename: P
authors.initials: P
authors.lastname: Petit
authors.affiliation: Service de spécialités pédiatriques et médecine infantile, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
authors.forename: B
authors.initials: B
authors.lastname: Chabrol
authors.affiliation: Service de spécialités pédiatriques et médecine infantile, CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France. Electronic address: emmanuelle.bosdure@ap-hm.fr.
authors.forename: E
authors.initials: E
authors.lastname: Bosdure
mesh_terms: D002648:Child; D002649:Child Abuse; D005602:France; D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*