ArticleBMJ open2016
Value of systematic detection of physical child abuse at emergency rooms: a cross-sectional diagnostic accuracy study.
Article in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 42 citations in OpenAlex.
- Screening tools used by paediatric healthcare providers to identify child maltreatment by parents or caregivers: a systematic review.BMJ open · 2025Pooled it
- Identifying children exposed to maltreatment: a systematic review update.BMC pediatrics · 2020Pooled it
- Improving the recognition of child maltreatment in emergency departments in Europe: healthcare professionals' perceived barriers and facilitators for implementation of a comprehensive toolkit design.European journal of pediatrics · 2026Article
- Enhancing implementation and compliance of the Screening Instrument for Child Abuse and Neglect (SCAN) in emergency departments in the Netherlands.BMJ paediatrics open · 2026Observational
- Clinical diagnosis and challenges in management of Osteogenesis Imperfecta in a resource-limited setting - A case report and review of literature.International journal of surgery case reports · 2025Article
- Evaluation of a Child Abuse Screen Performed by Nurses Among Young Children with Fractures Seen in a Pediatric Emergency Department.Rhode Island medical journal (2013) · 2024Observational
- Screening for Child Abuse in the Emergency Department of Academic Hospital Paramaribo in Suriname.Global pediatric health · 2024Article
- Diagnostic Tools in the Detection of Physical Child Abuse: A Systematic Review.Children (Basel, Switzerland) · 2022Review
- Electronic Health Record Tools to Identify Child Maltreatment: Scoping Literature Review and Key Informant Interviews.Academic pediatrics · 2022Article
- Orofacial injuries in child family homicide: a population study.Forensic science, medicine, and pathology · 2021Article
- Recognition of child maltreatment in emergency departments in Europe: Should we do better?PloS one · 2021Article
- Evaluation of the efficacy and impact of a clinical prediction tool to identify maltreatment associated with children's burns.BMJ paediatrics open · 2021Article
- Identifying Populations at Risk for Child Abuse: A Nationwide Analysis.Journal of pediatric surgery · 2020Article
- Finding the Victim of Abuse: A New Frontier of Physicians' Liability? Data From a Local Italian Experience on Minor Maltreatment.Frontiers in pediatrics · 2020Article
- Development of screening tool for child abuse in the korean emergency department: Using modified Delphi study.Medicine · 2018Review
- Child maltreatment identification rates in a child development center: suggestions for improved detection.European journal of pediatrics · 2018Article
- Classifying Injuries in Young Children as Abusive or Accidental: Reliability and Accuracy of an Expert Panel Approach.The Journal of pediatrics · 2018Observational
- The Value of a Checklist for Child Abuse in Out-of-Hours Primary Care: To Screen or Not to Screen.PloS one · 2017Article
- A screening protocol for child abuse at out-of-hours primary care locations: a descriptive study.BMC family practice · 2016Article
- A Qualitative Study Examining Stakeholder Perspectives of a Local Child Abuse Program in Community Emergency Departments.Academic pediatricsArticle
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury.
designA large multicentre study with a 6-month follow-up.
setting4 ERs in The Netherlands.
participants4290 children aged 0-7 years attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test). A national expert panel (reference standard) retrospectively assessed all children with positive screens and a 15% random sample of the children with negative screens for physical abuse, using additional information, namely, an injury history taken by a paediatrician, information provided by the general practitioner, youth doctor and social services by structured questionnaires, and 6-month follow-up information.
main outcome measurePhysical child abuse. SECONDARY OUTCOME MEASURE: Injury due to neglect and need for help.
results4253/4290 (99%) parents agreed to follow-up. At a prevalence of 0.07% (3/4253) for inflicted injury by expert panel decision, the positive predictive value of the checklist was 0.03 (95% CI 0.006 to 0.085), and the negative predictive value 1.0 (0.994 to 1.0). There was 100% (93 to 100) agreement about inflicted injury in children, with positive screens between the expert panel and child abuse experts.
conclusionsRare cases of inflicted injury among preschool children presenting at ERs for injury are very likely captured by easy-to-use checklists, but at very high false-positive rates. Subsequent assessment by child abuse experts can be safely restricted to children with positive screens at very low risk of missing cases of inflicted injury. Because of the high false positive rate, we do advise careful prior consideration of cost-effectiveness and clinical and societal implications before de novo implementation.
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