title: The Value of a Checklist for Child Abuse in Out-of-Hours Primary Care: To Screen or Not to Screen.
abstract: To assess the diagnostic value of the screening instrument SPUTOVAMO-R2 (checklist, 5 questions) for child abuse at Out-of-hours Primary Care locations (OPC), by comparing the test outcome with information from Child Protection Services (CPS). Secondary, to determine whether reducing the length of the checklist compromises diagnostic value.
  
  
  
  All children (<18 years) attending one of the participating OPCs in the region of Utrecht, the Netherlands, in a year time, were included. The checklist is an obligatory field in the electronic patient file. CPS provided data on all checklist positives and a sample of 5500 checklist negatives (dataset). The checklist outcome was compared with a report to CPS in 10 months follow up after the OPC visit.
  
  
  
  The checklist was filled in for 50671 children; 108 (0.2%) checklists were positive. Within the dataset, 61 children were reported to CPS, with emotional neglect as the most frequent type of abuse (32.8%). The positive predictive value (PPV) of the checklist for child abuse was 8.3 (95% CI 3.9-15.2). The negative predictive value (NPV) was 99.1 (98.8-99.3), with 52 false negatives. When the length of the checklist was reduced to two questions closely related to the medical process (SPUTOVAMO-R3), the PPV was 9.1 (3.7-17.8) and the NPV 99.1 (98.7-99.3). These two questions are on the injury in relation to the history, and the interaction between child and parents.
  
  
  
  The checklist SPUTOVAMO-R2 has a low detection rate of child abuse within the OPC setting, and a high false positive rate. Therefore, we recommend to use the shortened checklist only as a tool to increase the awareness of child abuse and not as a diagnostic instrument.
authors.affiliation: Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Maartje C M
authors.identifier: 0000-0001-5855-3124
authors.initials: MCM
authors.lastname: Schouten
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Henk F
authors.initials: HF
authors.lastname: van Stel
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Theo J M
authors.initials: TJM
authors.lastname: Verheij
authors.affiliation: Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Houben
authors.affiliation: Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Ingrid M B
authors.initials: IMB
authors.lastname: Russel
authors.affiliation: Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Edward E S
authors.initials: EES
authors.lastname: Nieuwenhuis
authors.affiliation: Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Elise M
authors.initials: EM
authors.lastname: van de Putte
mesh_terms: D000293:Adolescent; D000465:Algorithms; D057189:Checklist; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D000068216:Child Protective Services; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005189:False Positive Reactions; D005220:Fathers; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods; D009035:Mothers; D009426:Netherlands; D010290:Parents; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires