Intrahospital and Territorial Management of Violence Against Children in the Verbano-Cusio-Ossola Area, Northern Italy.

Violence against minors remains a significant, often under-reported public health crisis. This study evaluated the incidence and clinical management of child abuse within the Verbano-Cusio-Ossola area (Northwest Italy) from January 2017 to August 2023. A retrospective descriptive analysis was conducted using two primary data streams: (1) Territorial data: records from the multidisciplinary "Maltrattamento, Trascuratezza, Abuso" ("Maltreatment, Neglect, Abuse") team. (2) Hospital data: Pediatric Emergency Department admissions in Verbania and Domodossola, screened via diagnostic filters and ICD-related codes. At the territorial level, 161 minors were identified. While the territorial network demonstrated high activation rates (96.25%) and legal reporting (92.55%), a history of missed reports was noted in 8.13% of cases. Parental risk factors were prevalent: 72% of caregivers reported adverse childhood experiences and 27% presented with psychiatric comorbidities. In contrast, hospital data revealed a diagnostic gap. Out of 1,586 pediatric ED admissions, only one case was explicitly recorded as child abuse. Furthermore, none of the discharges utilized specific maltreatment diagnostic codes, despite several patients presenting with recurrent "accidental" traumas. These findings highlight a disconnect between community services and acute clinical settings. Enhancing intrahospital surveillance and implementing specialized training for healthcare providers are essential to bridge this diagnostic gap and ensure a coordinated, multidisciplinary response to child maltreatment.