Radiology, Emma Children's hospital, Academic Medical Center, Amsterdam, The Netherlands
Forensic Medicine, Nederlands Forensisch Instituut, Den Haag, The Netherlands.
BMJ Open. 2019 Aug 21;9(8):e031008. doi: 10.1136/bmjopen-2019-031008.
Combined paediatric and forensic medical expertise to interpret physical findings is not available in Dutch healthcare facilities. The Dutch Expertise Centre for Child Abuse (DECCA) was founded in the conviction that this combination is essential in assessing potential physical child abuse. DECCA is a collaboration between the three paediatric hospitals and the Netherlands Forensic Institute. DECCA works with Bayes' theorem and uses likelihood ratios in their conclusions.
We present the implementation process of DECCA and cross-sectional data of the first 4 years.
Between 14 December 2014 and 31 December 2018, a total of 761 advisory requests were referred, all of which were included in this study. An advisee evaluation over the year 2015 was performed using a self-constructed survey to gain insight in the first experiences with DECCA.
761 cases were included, 381 (50.1%) boys and 361 (47.4%) girls (19 cases (2.5%) sex undisclosed). Median age was 1.5 years (range 1 day to 20 years). Paediatricians (53.1%) and child safeguarding doctors (21.9%) most frequently contacted DECCA. The two most common reasons for referral were presence of injury/skin lesions (n=592) and clinical history inconsistent with findings (n=145). The most common injuries were bruises (264) and non-skull fractures (166). Outcome of DECCA evaluation was almost certainly no or improbable child abuse in 35.7%; child abuse likely or almost certain in 24.3%, and unclear in 12%. The advisee evaluations (response rate 50%) showed that 93% experienced added value and that 100% were (very) satisfied with the advice.
Data show growing interest in the expertise of DECCA through the years. DECCA seems to be a valuable addition to Dutch child protection, since advisee value the service and outcome of DECCA evaluations. In almost half of the cases, DECCA concluded that child abuse could not be substantiated.
荷兰的医疗保健机构缺乏儿科和法医医学专业知识相结合来解读身体检查结果。荷兰儿童虐待专家中心（DECCA）的成立基于这样一种信念，即这种结合对于评估潜在的身体虐待儿童至关重要。DECCA 是三家儿科医院和荷兰法医研究所之间的合作项目。DECCA 使用贝叶斯定理，并在其结论中使用似然比。
我们介绍了 DECCA 的实施过程和前 4 年的横断面数据。
2014 年 12 月 14 日至 2018 年 12 月 31 日，共转介了 761 项咨询请求，所有这些请求都包含在本研究中。2015 年对咨询者进行了一项自我构建的调查，以深入了解他们对 DECCA 的第一手经验。
共纳入 761 例病例，其中男 381 例（50.1%），女 361 例（47.4%）（19 例（2.5%）性别未披露）。中位年龄为 1.5 岁（范围为 1 天至 20 岁）。儿科医生（53.1%）和儿童保护医生（21.9%）最常联系 DECCA。转介的两个最常见原因是存在损伤/皮肤损伤（n=592）和临床病史与检查结果不一致（n=145）。最常见的损伤是瘀伤（264）和非颅骨骨折（166）。DECCA 评估的结果几乎可以肯定没有或不太可能发生儿童虐待的占 35.7%；儿童虐待可能性大或几乎肯定的占 24.3%，不确定的占 12%。咨询者的评估（响应率 50%）显示，93%的人认为增加了价值，并且 100%的人（非常）对咨询的建议感到满意。
数据显示，多年来，DECCA 的专业知识越来越受到关注。DECCA 似乎是荷兰儿童保护的一项有价值的补充，因为咨询者重视 DECCA 评估的服务和结果。在近一半的情况下，DECCA 的结论是无法证实虐待儿童的行为。
