A screening protocol for child abuse at out-of-hours primary care locations: a descriptive study.
Child abuse is often unrecognized at out-of-hours primary care (OOH-PC) services. The aim of our study was to evaluate the clinical outcome of the screening instrument SPUTOVAMO-R2 for child abuse (checklist), followed by a structured approach (reporting code), at OOH-PC services. The reporting code with five steps should ensure consistent action in case of a suspicion.



All children attending one of the five participating OOH-PC services in the region of Utrecht, the Netherlands, in a year time, were included. The checklist is an obligatory field in the electronic patient file and was filled in for all children. In case of a positive checklist, the steps in the reporting code were followed. Additionally, the case was evaluated in a multidisciplinary team to determine the probability of child abuse.



The checklist was filled in for 50671 children; 108 (0.2 %) were positive. The multidisciplinary team diagnosed child abuse in 24 (22 %) of the 108 positive checklists, and no child abuse in 36 (33 %). Emotional neglect was the most frequent type of abuse diagnosed. For all abused children, care was implemented according to the protocol. The most frequent care given was a referral to the hospital (N = 7) or contact with child's own general practitioner (N = 6).



A checklist followed by a reporting code guarantees consistent actions and care for children with a suspicion of child abuse. The percentage of positive checklists is lower than expected. Validity of the checklist should be assessed in a diagnostic study.
Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands. m.c.m.schouten@umcutrecht.nl.|Division of Pediatrics, Wilhelmina Children's Hospital, Postbox 85090, 3508 AB, Utrecht, The Netherlands. m.c.m.schouten@umcutrecht.nl.
Maartje C M
MC
Schouten
Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
Henk F
HF
van Stel
Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
Theo J M
TJ
Verheij
Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
Edward E S
EE
Nieuwenhuis
Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
Elise M
EM
van de Putte
D000293:Adolescent; D039602:After-Hours Care / Q000379:methods*; D057189:Checklist; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000628:therapy; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010348:Patient Care Team; D011320:Primary Health Care / Q000379:methods*
Child abuse; Mass screening; Primary health care