Diderich Hester M, Fekkes Minne, Verkerk Paul H, Pannebakker Fieke D, Velderman Mariska Klein, Sorensen Peggy J G, Baeten Paul, Oudesluys-Murphy Anne Marie
Emergency Department, Medical Centre Haaglanden, Lijnbaan 32, PO Box 432, 2501 CK The Hague, The Netherlands.
Department of Child Health, TNO, Wassenaarseweg 56, PO Box 2215, 2301 CE Leiden, The Netherlands.
Child Abuse Negl. 2013 Dec;37(12):1122-31. doi: 10.1016/j.chiabu.2013.04.005. Epub 2013 Jun 12.
Identifying child abuse and neglect solely on the grounds of child characteristics leaves many children undetected. We developed a new approach (Hague protocol) based on characteristics of parents who attend the Emergency Department (ED) because they have the following problems: (1) intimate partner violence, (2) substance abuse, or (3) suicide attempt or other serious psychiatric problems. The goal of this protocol is to enable the Reporting Center for Child Abuse and Neglect (RCCAN) to rapidly assess family problems and offer voluntary community based support to these parents. The aim of this study is to assess whether this protocol for screening adults presenting for care in the Emergency Department can identify children at high risk for maltreatment. A before and after study was conducted at 9 EDs in 3 regions in the Netherlands (one intervention region and 2 control regions). During the period January 2006 to November 2007, prior to the introduction of the Hague protocol, from a total of 385,626 patients attending the ED in the intervention region 4 parents (1 per 100,000) were referred to the RCCAN. In the period after introduction of the protocol (December 2007 to December 2011), the number rose to 565 parents from a total of 885,301 patients attending the ED (64 per 100,000). In the control region, where the protocol was not implemented, these figures were 2 per 163,628 (1 per 100,000) and 10 per 371,616 (3 per 100,000) respectively (OR=28.0 (95 CI 4.6-170.7)). At assessment, child abuse was confirmed in 91% of referred cases. The protocol has a high positive predictive value of 91% and can substantially increase the detection rate of child abuse in an ED setting. Parental characteristics are strong predictors of child abuse. Implementing guidelines to detect child abuse based on parental characteristics of parents attending the adult section of the ED can increase the detection rate of child abuse and neglect allowing appropriate aid to be initiated for these families.
仅依据儿童自身特征来识别虐待和忽视儿童的情况会导致许多此类儿童未被发现。我们基于前往急诊科（ED）的父母的特征开发了一种新方法（海牙协议），这些父母存在以下问题：（1）亲密伴侣暴力，（2）药物滥用，或（3）自杀未遂或其他严重精神问题。该协议的目标是使虐待和忽视儿童报告中心（RCCAN）能够迅速评估家庭问题，并为这些父母提供基于社区的自愿支持。本研究的目的是评估这种针对在急诊科就诊的成年人的筛查协议能否识别出受虐待风险高的儿童。在荷兰3个地区的9个急诊科进行了一项前后对照研究（1个干预地区和2个对照地区）。在2006年1月至2007年11月期间，即在海牙协议引入之前，干预地区共有385,626名患者前往急诊科就诊，其中4名家长（每10万人中有1人）被转介至RCCAN。在协议引入之后的时期（2007年12月至2011年12月），在前往急诊科就诊的885,301名患者中，转介的家长人数增至565人（每10万人中有64人）。在未实施该协议的对照地区，这些数字分别为每163,628人中有2人（每10万人中有1人）和每371,616人中有10人（每10万人中有3人）（比值比=28.0（95%置信区间4.6 - 170.7））。在评估时，91%的转介病例被确认为存在虐待儿童情况。该协议具有91%的高阳性预测值，并且能够大幅提高急诊科环境中虐待儿童情况的检出率。父母的特征是虐待儿童的有力预测因素。实施基于前往急诊科成人科室就诊的父母的特征来检测虐待儿童情况的指南，可以提高虐待和忽视儿童情况的检出率，并为这些家庭启动适当援助。
