[Suspected child abuse in paediatric emergency service]

[Child abuse in the Emergency department: Epidemiology, management, and follow-up]

OBJECTIVE

To describe the clinical and epidemiological features, management, and follow-up of child abuse suspicions diagnosed in the Paediatric Emergency Unit.

METHODS

A single-centre, observational and retrospective study was conducted between 2008 and 2017. Clinical, epidemiological and follow-up data were collected in those patients younger than 16 that were reported as child abuse suspicions. A descriptive and analytic study was performed, as well as a bivariate and multivariate analysis.

RESULTS

A total of 404 out of 570,648 emergency patients (0.07%) were diagnosed with potential abuse. Physical abuse was the most frequent kind of abuse (40.3%). The median age was 4.3 years (IQR 1.6-10.2), and 55% were girls, with sexual abuse being more common in them (OR 3.71; 95% CI: 2.23-6.17), and physical abuse more frequent in boys (OR 1.72; 95% CI: 1.15-2.57). A total of 89 patients (22%) required admission. Age and type of abuse were independently associated with risk of admission. More than half (56%) of the cases required additional follow-up, with sexual (OR 3.98; 95% CI: 1.93-7.03) and emotional abuse (OR 4.93; 95% CI: 1.82-13.35) requiring more mental health follow-up, and physical abuse requiring more social services follow-up (OR 4.39; 95% CI: 1.61-11.98).

CONCLUSIONS

In our study, child abuse is more frequent in pre-school children. Age and type of abuse are associated with the need of admission. The kind of follow-up is determined by the type of abuse.

[Hospital admissions due to child maltreatment over a fifteen year period]

AIM

To measure the incidence of admissions for maltreatment between 1995 and 2009 and to determine their main clinical and epidemiological characteristics.

METHODS

Retrospective review of children diagnosed with maltreatment over 15 years in a third level hospital.

RESULTS

A total of 97 cases (median incidence 0.5 cases per 1000 children admitted per year) were found. There was an increasing rate of physical maltreatment, while those of sexual abuse declined. 51 (53.6%) female; median age 3.3 years (p25-75: 7.6 months-10.0 years). Just under half (43.3%) or 42 patients, had a primary complaint unrelated to abuse. The most common injuries were haematomas (43; 44.3%). In 91 (93.8%) cases the perpetrator was found to be a member of the child's own family (77; 74.9%, one of the parents or both).

CONCLUSIONS

The increase in admissions for physical maltreatment stresses the need to insist in a prevention policy. The decrease in admissions for sexual abuse was probably attributable to changes in the care circuit rather than a real decrease. In almost half of the cases the suspicion of maltreatment arose upon physical examination or after complementary tests, making it advisable that maltreatment is included in the differential diagnosis in multiple consultations. The majority of maltreatment occurred in the context of the victim's family.