Abstract
The objective of this study is to develop and validate a screening instrument for the recognition of child maltreatment in the emergency department (ED). Existing data on screening questions and outcomes (diagnosis of child maltreatment) from three large observational screening studies at eight different EDs in the Netherlands were harmonized. A multivariate logistic regression was performed to develop the Screening instrument for Child Abuse and Neglect (SCAN). The SCAN was validated by performing a cross-validation and calculating the discriminative ability. A total of 24,963 patients were included. Out of the potential screening questions the following questions were included in the final instrument: is the injury compatible with the history, and does it correspond to the child’s developmental level? (aOR 10.40, 95% CI 5.69–19.02), was there an unnecessary delay in seeking medical help? (aOR 3.45, 95% CI 1.73–6.88) and is the behaviour/interaction of the child and parents (carers) appropriate? (aOR 14.67, 95% CI 7.93–27.13). The SCAN had a pooled AUC of 0.75 (95% CI 0.63–0.87) in the cross-validation. The question “Are there other signals that make you doubt the safety of the child and/or family?” (available in only one of the original datasets, OR 182.9; 95% CI 102.3–327.4) was by consensus added to the final SCAN. Conclusion: This validated and brief Screening instrument for Child Abuse and Neglect (SCAN) is designed to improve early recognition of child maltreatment in the ED. A positive screening result of the SCAN warrants a thorough work-up for child maltreatment, including a top-toe examination, if necessary additional diagnostics and adequate safety measures.What is Known:• Screening instruments increase the detection of possible cases of child maltreatment in the emergency department and support health care professionals to identify these cases.• The application of different screening instruments led to the need for one brief validated instrument.What is New:• This study presents a validated and brief Screening instrument for Child Abuse and Neglect (SCAN), consisting of four questions.• The SCAN supports professionals in detecting signals of child maltreatment, and a positive screening result should lead to a thorough work-up, including a top-toe examination, complete history, additional diagnostic tests and consultation of a child abuse expert.
Original language | English |
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Pages (from-to) | 79-87 |
Number of pages | 9 |
Journal | European Journal of Pediatrics |
Volume | 182 |
Issue number | 1 |
Early online date | 5 Oct 2022 |
DOIs | |
Publication status | Published - Jan 2023 |
Bibliographical note
Funding Information:Only the original studies, from which any data were used, were originally funded as follows: AMC: this study was supported by Stichting Kinderpostzegels Nederland. EMC: this study was supported by the Netherlands Institute for Health Research and Development (ZonMw 63300023) and Foundation Physico Therapeutic Institute. UMC: this study was supported by the Netherlands Institution for Health Research and Development (ZonMw 80–82405–98–084, project number 15700.1008). KGMM receives funding from the Netherlands Organization for Scientific Research (projects 9120.8004 and 918.10.615).
Publisher Copyright:
© 2022, The Author(s).