Signals in the hospital Emergency Room linking objective signs to child abuse knowledge: ShERlock study

In this thesis we bring together our studies on screening for and addressing of child abuse and neglect (CAN) in the Academic Medical Center (AMC) in Amsterdam. These studies concern the approach in our academic hospital in general and in particular the approach at the Emergency Department (ED). We describe the results of a new screening method for child abuse at this department, combining a well-known checklist for CAN, the so-called SPUTOVAMO checklist, with an inspection of the fully undressed child, the so-called ‘top-toe’ inspection (TTI).
We showed higher accuracy results and higher prevalence of CAN in our total and screened study group compared to other Dutch studies, both for the individual tests and for the combination. We showed in the group of children in which combined screening was completed 5.8% of children with a positive diagnosis had only a positive TTI, and could have been missed with SPUTOVAMO only. Vice versa 20% with a positive diagnosis had only a positive SPUTOVAMO and a negative TTI, and could have been missed with TTI only.
We recommend the implementation of the combined screening with SPUTOVAMO and TTI in every ED for all children 0-18 years old, at the cost of a high false-positive rate.