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. 2005 Apr;90(4):406–410. doi: 10.1136/adc.2003.040790

Observational study of suspected maltreatment in Italian paediatric emergency departments

S Palazzi 1, G de Girolamo 1, T Liverani 1, b on 1
PMCID: PMC1720360  PMID: 15781934

Abstract

Aims: To evaluate how often children seen in paediatric accident & emergency (A&E) departments were suspected of abuse or neglect, and to explore some of the correlates of suspected child maltreatment.

Methods: Multicentre, cross-sectional study of 15 randomised census days during a six month period. Trained research assistants working with local paediatric staff completed a purpose made anonymised checklist covering sociodemographic and medical information. A six point suspicion index was used to rate compatibility with child maltreatment based on the occurrence of observable harm. Statistical analysis was carried out on the basis that a score of 4 or more was suspicious of child maltreatment. Nineteen hospitals provided standardised paediatric A&E consultation data on 0–14 year olds presenting between 10 am and 10 pm.

Results: Of 10 175 assessed children, 204 aroused suspicion of child maltreatment (95% CI 163 to 214 per 10 000). In a logistic regression model of suspected maltreatment statistically significant associations were found with socioeconomic disadvantage, children living in single parent families, and developmental delay. There was no correlation with pre-school age, male gender, foreign origin, or living in urban areas.

Conclusions: Child maltreatment based on immediate scoring of suspicion, focused on observable harm, occurred in 2% of a representative sample of paediatric emergency consultations in Italy. This was more common if there were associated social and developmental vulnerabilities. True prevalence of child maltreatment in emergency departments remains elusive because of changing definitions and forensic validation problems.

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Figure 1.

Figure 1

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 Child maltreatment suspected by paediatric emergency staff (%). Approximate locations of participating hospitals and ratios of children scoring 4 or above in "compatibility with the concept of child abuse or neglect, understood as physical, sexual, or mental harm (i.e. non-subjective evidence of injury suffered because of others, known or unknown)". Scale: 1, ruled out; 2, almost excluded; 3, very dubious; 4, dubious; 5, almost certain; 6, certain. Clinicians did not know what threshold was to be set.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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