Louwers Eveline C F M, Korfage Ida J, Affourtit Marjo J, Ruige Madelon, van den Elzen Annette P M, de Koning Harry J, Moll Henriëtte A
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Child Abuse Negl. 2014 Jul;38(7):1275-81. doi: 10.1016/j.chiabu.2013.11.005. Epub 2013 Dec 9.
Although screening for child abuse at emergency departments (EDs) increases the detection rate of potential child abuse, an accurate instrument is lacking. This study was designed to measure the accuracy of a screening instrument for detection of potential child abuse used in EDs. In a prospective cohort study at three Dutch EDs, a 6-item screening instrument for child abuse, Escape, was completed for each child visiting the ED. The data from the completed Escape instrument was used to calculate sensitivity, specificity, and the positive/negative predictive value per item. The clinical notes and conclusions of the screen instruments of all potentially abused children reported to the hospitals' Child Abuse Teams were collected and reviewed by an expert panel. A logistic regression model was used to evaluate the predictors of potential abuse. Completed Escape instruments were available for 18,275 ED visits. Forty-four of the 420 children with a positive screening result, and 11 of the 17,855 children with a negative result were identified as potentially abused. Sensitivity of the Escape instrument was 0.80 and specificity was 0.98. Univariate logistic regression showed that potentially abused children were significantly more likely to have had an aberrant answer to at least one of the items, OR=189.8, 95% CI [97.3, 370.4]. Most of the children at high risk for child abuse were detected through screening. The Escape instrument is a useful tool for ED staff to support the identification of those at high risk for child abuse.
尽管在急诊科对虐待儿童情况进行筛查可提高潜在虐待儿童的检出率，但目前缺乏一种准确的筛查工具。本研究旨在评估一种用于急诊科检测潜在虐待儿童的筛查工具的准确性。在荷兰三家急诊科开展的一项前瞻性队列研究中，为每位前往急诊科就诊的儿童填写一份包含6个条目的虐待儿童筛查工具Escape。已完成的Escape工具的数据用于计算每个条目的敏感性、特异性以及阳性/阴性预测值。所有上报给医院虐待儿童问题处理小组的疑似受虐儿童的筛查工具临床记录及结论，均由一个专家小组收集并审核。采用逻辑回归模型评估潜在虐待的预测因素。共有18275次急诊科就诊的Escape工具填写完整。420名筛查结果为阳性的儿童中有44名，17855名筛查结果为阴性的儿童中有11名被确定为潜在受虐儿童。Escape工具的敏感性为0.80，特异性为0.98。单因素逻辑回归显示，潜在受虐儿童对至少一个条目给出异常回答的可能性显著更高，比值比=189.8，95%置信区间[97.3, 370.4]。大多数虐待儿童高危风险儿童通过筛查被检出。Escape工具是急诊科工作人员识别虐待儿童高危风险儿童的有用工具。
