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Child Abuse Negl. 2013 Dec;37(12):1122-31. doi: 10.1016/j.chiabu.2013.04.005. Epub 2013 Jun 12.

A new protocol for screening adults presenting with their own medical problems at the Emergency Department to identify children at high risk for maltreatment.

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Emergency Department, Medical Centre Haaglanden, Lijnbaan 32, PO Box 432, 2501 CK The Hague, The Netherlands.
Department of Child Health, TNO, Wassenaarseweg 56, PO Box 2215, 2301 CE Leiden, The Netherlands.
Advice and Reporting Centre for Child Abuse, Neherkade 3054, 2521 VX The Hague, The Netherlands.
Social Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.


Identifying child abuse and neglect solely on the grounds of child characteristics leaves many children undetected. We developed a new approach (Hague protocol) based on characteristics of parents who attend the Emergency Department (ED) because they have the following problems: (1) intimate partner violence, (2) substance abuse, or (3) suicide attempt or other serious psychiatric problems. The goal of this protocol is to enable the Reporting Center for Child Abuse and Neglect (RCCAN) to rapidly assess family problems and offer voluntary community based support to these parents. The aim of this study is to assess whether this protocol for screening adults presenting for care in the Emergency Department can identify children at high risk for maltreatment. A before and after study was conducted at 9 EDs in 3 regions in the Netherlands (one intervention region and 2 control regions). During the period January 2006 to November 2007, prior to the introduction of the Hague protocol, from a total of 385,626 patients attending the ED in the intervention region 4 parents (1 per 100,000) were referred to the RCCAN. In the period after introduction of the protocol (December 2007 to December 2011), the number rose to 565 parents from a total of 885,301 patients attending the ED (64 per 100,000). In the control region, where the protocol was not implemented, these figures were 2 per 163,628 (1 per 100,000) and 10 per 371,616 (3 per 100,000) respectively (OR=28.0 (95 CI 4.6-170.7)). At assessment, child abuse was confirmed in 91% of referred cases. The protocol has a high positive predictive value of 91% and can substantially increase the detection rate of child abuse in an ED setting. Parental characteristics are strong predictors of child abuse. Implementing guidelines to detect child abuse based on parental characteristics of parents attending the adult section of the ED can increase the detection rate of child abuse and neglect allowing appropriate aid to be initiated for these families.


Child abuse and neglect; Emergency Department; Intimate partner violence; Psychiatric problems; Substance abuse

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