Child abuse screening fails
Child abuse entails tremendous repercussions; early detection is therefore essential.
In support of early detection, the use of a 'child abuse screening instrument' was introduced as a mandatory procedure in out-of-hours primary care centers in 2011. Till now, it was uncertain whether this screening instrument provided reliable results for establishing or dismissing child abuse. Maartje Schouten, PhD student under the supervision of Prof. Dr. Th.J.M. Verheij (Julius Center) examined the ability of out-of-hours primary care locations to detect child abuse.
Over 5.000 children who visited one of the five participating primary healthcare centers during the course of a year were screened. She compared the result produced through the screening instrument against the reference test: a notification to Veilig Thuis (Safe Home) within ten months of the child's visit to the out-of-hours primary care location.
The screening instrument has demonstrated only limited reliability. Due to its low detection rate and high false positive value, Maartje concluded that it is not suitable for use as a diagnostic tool.
If a screening instrument produces false results, child and parents can suffer huge consequences. Maartje concludes in her thesis that it would be better to use the screening tool to increase awareness of child abuse instead of as a diagnostic test. Developing and using diagnostic tests for specific injuries, such as fractures or bruises, seems more promising. Maartje and her colleagues argue in favor of developing injury-specific diagnostic tests. Furthermore, they recommend that mandatory screening for child abuse be rescinded in order to prevent misleading results. Lastly, they advocate the development of a national detection protocol for emergency medical care.
Maartje Schouten, PhD student under the supervision of Prof. Dr. E.E.S. Nieuwenhuis and Prof. Dr. Th.J.M. Verheij and the co-supervision of Dr. E.M. van de Putte and H.F. van Stel will defend her thesis entitled ‘Systematic Screening for Child Abuse in the Out-of-hours Primary Care’ on March 23rd at 2:45 p.m. in the Academy Building in Utrecht.