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  1. Article ; Online: Implementation of the Dutch expertise centre for child abuse: descriptive data from the first 4 years.

    van Rijn, Rick Robert / Affourtit, Marjo J / Karst, Wouter A / Kamphuis, Mascha / de Bock, Leonie C / van de Putte, Elise

    BMJ open

    2019  Volume 9, Issue 8, Page(s) e031008

    Abstract: Objective: Combined paediatric and forensic medical expertise to interpret physical findings is not available in Dutch healthcare facilities. The Dutch Expertise Centre for Child Abuse (DECCA) was founded in the conviction that this combination is ... ...

    Abstract Objective: Combined paediatric and forensic medical expertise to interpret physical findings is not available in Dutch healthcare facilities. The Dutch Expertise Centre for Child Abuse (DECCA) was founded in the conviction that this combination is essential in assessing potential physical child abuse. DECCA is a collaboration between the three paediatric hospitals and the Netherlands Forensic Institute. DECCA works with Bayes' theorem and uses likelihood ratios in their conclusions.
    Design: We present the implementation process of DECCA and cross-sectional data of the first 4 years.
    Participants: Between 14 December 2014 and 31 December 2018, a total of 761 advisory requests were referred, all of which were included in this study. An advisee evaluation over the year 2015 was performed using a self-constructed survey to gain insight in the first experiences with DECCA.
    Results: 761 cases were included, 381 (50.1%) boys and 361 (47.4%) girls (19 cases (2.5%) sex undisclosed). Median age was 1.5 years (range 1 day to 20 years). Paediatricians (53.1%) and child safeguarding doctors (21.9%) most frequently contacted DECCA. The two most common reasons for referral were presence of injury/skin lesions (n=592) and clinical history inconsistent with findings (n=145). The most common injuries were bruises (264) and non-skull fractures (166). Outcome of DECCA evaluation was almost certainly no or improbable child abuse in 35.7%; child abuse likely or almost certain in 24.3%, and unclear in 12%. The advisee evaluations (response rate 50%) showed that 93% experienced added value and that 100% were (very) satisfied with the advice.
    Conclusion: Data show growing interest in the expertise of DECCA through the years. DECCA seems to be a valuable addition to Dutch child protection, since advisee value the service and outcome of DECCA evaluations. In almost half of the cases, DECCA concluded that child abuse could not be substantiated.
    MeSH term(s) Adolescent ; Age Factors ; Bayes Theorem ; Child ; Child Abuse/diagnosis ; Child Abuse/statistics & numerical data ; Child, Preschool ; Cross-Sectional Studies ; Female ; Forensic Medicine/methods ; Humans ; Infant ; Male ; Medical History Taking/statistics & numerical data ; Netherlands
    Language English
    Publishing date 2019-08-21
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2747269-3
    ISSN 2044-6055 ; 2044-6055 ; 2053-3624
    ISSN (online) 2044-6055
    ISSN 2044-6055 ; 2053-3624
    DOI 10.1136/bmjopen-2019-031008
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  2. Article ; Online: Facilitators and barriers to screening for child abuse in the emergency department

    Louwers Eveline CFM / Korfage Ida J / Affourtit Marjo J / De Koning Harry J / Moll Henriëtte A

    BMC Pediatrics, Vol 12, Iss 1, p

    2012  Volume 167

    Abstract: Abstract Background To identify facilitators of, and barriers to, screening for child abuse in emergency departments (ED) through interviews with ED staff, members of the hospital Board, and related experts. Methods This qualitative study is based on ... ...

    Abstract Abstract Background To identify facilitators of, and barriers to, screening for child abuse in emergency departments (ED) through interviews with ED staff, members of the hospital Board, and related experts. Methods This qualitative study is based on semi-structured interviews with 27 professionals from seven Dutch hospitals (i.e. seven pediatricians, two surgeons, six ED nurses, six ED managers and six hospital Board members). The resulting list of facilitators/barriers was subsequently discussed with five experts in child abuse and one implementation expert. The results are ordered using the Child Abuse Framework of the Dutch Health Care Inspectorate that legally requires screening for child abuse. Results Lack of knowledge of child abuse, communication with parents in the case of suspected abuse, and lack of time for development of policy and cases are barriers for ED staff to screen for child abuse. For Board members, lack of means and time, and a high turnover of ED staff are impediments to improving their child abuse policy. Screening can be promoted by training ED staff to better recognize child abuse, improving communication skills, appointing an attendant specifically for child abuse, explicit support of the screening policy by management, and by national implementation of an approved protocol and validated screening instrument. Conclusions ED staff are motivated to work according to the Dutch Health Care Inspectorate requirements but experiences many barriers, particularly communication with parents of children suspected of being abused. Introduction of a national child abuse protocol can improve screening on child abuse at EDs.
    Keywords Child abuse ; Emergency department ; Screening ; Qualitative study ; Pediatrics ; RJ1-570 ; Medicine ; R ; DOAJ:Pediatrics ; DOAJ:Medicine (General) ; DOAJ:Health Sciences
    Subject code 360
    Language English
    Publishing date 2012-10-01T00:00:00Z
    Publisher BioMed Central
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Facilitators and barriers to screening for child abuse in the emergency department.

    Louwers, Eveline C F M / Korfage, Ida J / Affourtit, Marjo J / De Koning, Harry J / Moll, Henriëtte A

    BMC pediatrics

    2012  Volume 12, Page(s) 167

    Abstract: Background: To identify facilitators of, and barriers to, screening for child abuse in emergency departments (ED) through interviews with ED staff, members of the hospital Board, and related experts.: Methods: This qualitative study is based on semi- ... ...

    Abstract Background: To identify facilitators of, and barriers to, screening for child abuse in emergency departments (ED) through interviews with ED staff, members of the hospital Board, and related experts.
    Methods: This qualitative study is based on semi-structured interviews with 27 professionals from seven Dutch hospitals (i.e. seven pediatricians, two surgeons, six ED nurses, six ED managers and six hospital Board members). The resulting list of facilitators/barriers was subsequently discussed with five experts in child abuse and one implementation expert. The results are ordered using the Child Abuse Framework of the Dutch Health Care Inspectorate that legally requires screening for child abuse.
    Results: Lack of knowledge of child abuse, communication with parents in the case of suspected abuse, and lack of time for development of policy and cases are barriers for ED staff to screen for child abuse. For Board members, lack of means and time, and a high turnover of ED staff are impediments to improving their child abuse policy. Screening can be promoted by training ED staff to better recognize child abuse, improving communication skills, appointing an attendant specifically for child abuse, explicit support of the screening policy by management, and by national implementation of an approved protocol and validated screening instrument.
    Conclusions: ED staff are motivated to work according to the Dutch Health Care Inspectorate requirements but experiences many barriers, particularly communication with parents of children suspected of being abused. Introduction of a national child abuse protocol can improve screening on child abuse at EDs.
    MeSH term(s) Child ; Child Abuse/diagnosis ; Emergency Service, Hospital/standards ; Humans ; Interviews as Topic ; Surveys and Questionnaires
    Language English
    Publishing date 2012-10-23
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2041342-7
    ISSN 1471-2431 ; 1471-2431
    ISSN (online) 1471-2431
    ISSN 1471-2431
    DOI 10.1186/1471-2431-12-167
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  4. Article ; Online: Accuracy of a screening instrument to identify potential child abuse in emergency departments.

    Louwers, Eveline C F M / Korfage, Ida J / Affourtit, Marjo J / Ruige, Madelon / van den Elzen, Annette P M / de Koning, Harry J / Moll, Henriëtte A

    Child abuse & neglect

    2014  Volume 38, Issue 7, Page(s) 1275–1281

    Abstract: Although screening for child abuse at emergency departments (EDs) increases the detection rate of potential child abuse, an accurate instrument is lacking. This study was designed to measure the accuracy of a screening instrument for detection of ... ...

    Abstract Although screening for child abuse at emergency departments (EDs) increases the detection rate of potential child abuse, an accurate instrument is lacking. This study was designed to measure the accuracy of a screening instrument for detection of potential child abuse used in EDs. In a prospective cohort study at three Dutch EDs, a 6-item screening instrument for child abuse, Escape, was completed for each child visiting the ED. The data from the completed Escape instrument was used to calculate sensitivity, specificity, and the positive/negative predictive value per item. The clinical notes and conclusions of the screen instruments of all potentially abused children reported to the hospitals' Child Abuse Teams were collected and reviewed by an expert panel. A logistic regression model was used to evaluate the predictors of potential abuse. Completed Escape instruments were available for 18,275 ED visits. Forty-four of the 420 children with a positive screening result, and 11 of the 17,855 children with a negative result were identified as potentially abused. Sensitivity of the Escape instrument was 0.80 and specificity was 0.98. Univariate logistic regression showed that potentially abused children were significantly more likely to have had an aberrant answer to at least one of the items, OR=189.8, 95% CI [97.3, 370.4]. Most of the children at high risk for child abuse were detected through screening. The Escape instrument is a useful tool for ED staff to support the identification of those at high risk for child abuse.
    MeSH term(s) Adolescent ; Child ; Child Abuse/diagnosis ; Child, Preschool ; Emergency Service, Hospital/standards ; Female ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Male ; Mass Screening/methods ; Mass Screening/standards ; Netherlands ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Surveys and Questionnaires/standards
    Language English
    Publishing date 2014-07
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't ; Validation Studies
    ZDB-ID 799143-5
    ISSN 1873-7757 ; 0145-2134
    ISSN (online) 1873-7757
    ISSN 0145-2134
    DOI 10.1016/j.chiabu.2013.11.005
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  5. Article ; Online: Screening for child abuse at emergency departments: a systematic review.

    Louwers, Eveline C F M / Affourtit, Marjo J / Moll, Henriette A / de Koning, Harry J / Korfage, Ida J

    Archives of disease in childhood

    2010  Volume 95, Issue 3, Page(s) 214–218

    Abstract: Introduction: Child abuse is a serious problem worldwide and can be difficult to detect. Although children who experience the consequences of abuse will probably be treated at an emergency department, detection rates of child abuse at emergency ... ...

    Abstract Introduction: Child abuse is a serious problem worldwide and can be difficult to detect. Although children who experience the consequences of abuse will probably be treated at an emergency department, detection rates of child abuse at emergency departments remain low.
    Objective: To identify effective interventions applied at emergency departments that significantly increase the detection rate of confirmed cases of child abuse.
    Design: This review was carried out according to the Cochrane Handbook. Two reviewers individually searched PubMed, the Cochrane Library, EMBASE, Web of Science and CINAHL for papers that met the inclusion criteria.
    Results: Fifteen papers describing interventions were selected and reviewed; four of these were finally included and assessed for quality. In these studies the intervention consisted of a checklist of indicators of risk for child abuse. After implementation, the rate of detected cases of suspected child abuse increased by 180% (weighted mean in three studies). The number of confirmed cases of child abuse, reported in two out of four studies, showed no significant increase.
    Conclusions: Interventions at emergency departments to increase the detection rate of cases of confirmed child abuse are scarce in the literature. Past study numbers and methodology have been inadequate to show conclusive evidence on effectiveness.
    MeSH term(s) Adolescent ; Child ; Child Abuse/diagnosis ; Child, Preschool ; Emergency Service, Hospital/standards ; Emergency Service, Hospital/trends ; Humans ; Infant ; Infant, Newborn ; Mass Screening/methods ; Mass Screening/trends ; Risk Factors
    Language English
    Publishing date 2010-03
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 524-1
    ISSN 1468-2044 ; 0003-9888 ; 1359-2998
    ISSN (online) 1468-2044
    ISSN 0003-9888 ; 1359-2998
    DOI 10.1136/adc.2008.151654
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  6. Article ; Online: Detection of child abuse in emergency departments: a multi-centre study.

    Louwers, Eveline C F M / Korfage, Ida J / Affourtit, Marjo J / Scheewe, Dop J H / van de Merwe, Marjolijn H / Vooijs-Moulaert, Francoise A F S R / Woltering, Claire M C / Jongejan, Mieke H T M / Ruige, Madelon / Moll, Henriëtte A / De Koning, Harry J

    Archives of disease in childhood

    2011  Volume 96, Issue 5, Page(s) 422–425

    Abstract: Objective: This study examines the detection rates of suspected child abuse in the emergency departments of seven Dutch hospitals complying and not complying with screening guidelines for child abuse.: Design: Data on demographics, diagnosis and ... ...

    Abstract Objective: This study examines the detection rates of suspected child abuse in the emergency departments of seven Dutch hospitals complying and not complying with screening guidelines for child abuse.
    Design: Data on demographics, diagnosis and suspected child abuse were collected for all children aged ≤18 years who visited the emergency departments over a 6-month period. The completion of a checklist of warning signs of child abuse in at least 10% of the emergency department visits was considered to be compliance with screening guidelines.
    Results: A total of 24 472 visits were analysed, 54% of which took place in an emergency department complying with screening guidelines. Child abuse was suspected in 52 children (0.2%). In 40 (77%) of these 52 cases, a checklist of warning signs had been completed compared with a completion rate of 19% in the total sample. In hospitals complying with screening guidelines for child abuse, the detection rate was higher (0.3%) than in those not complying (0.1%, p<0.001).
    Conclusion: During a 6-month period, emergency department staff suspected child abuse in 0.2% of all children visiting the emergency department of seven Dutch hospitals. The numbers of suspected abuse cases detected were low, but an increase is likely if uniform screening guidelines are widely implemented.
    MeSH term(s) Adolescent ; Child ; Child Abuse/diagnosis ; Child Abuse/statistics & numerical data ; Child, Preschool ; Emergency Service, Hospital/standards ; Female ; Guideline Adherence/statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Male ; Mass Screening/methods ; Mass Screening/standards ; Netherlands/epidemiology ; Practice Guidelines as Topic
    Language English
    Publishing date 2011-01-30
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 524-1
    ISSN 1468-2044 ; 0003-9888 ; 1359-2998
    ISSN (online) 1468-2044
    ISSN 0003-9888 ; 1359-2998
    DOI 10.1136/adc.2010.202358
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  7. Article ; Online: Effects of systematic screening and detection of child abuse in emergency departments.

    Louwers, Eveline C F M / Korfage, Ida J / Affourtit, Marjo J / Scheewe, Dop J H / van de Merwe, Marjolijn H / Vooijs-Moulaert, Anne-Françoise S R / van den Elzen, Annette P M / Jongejan, Mieke H T M / Ruige, Madelon / Manaï, Badies H A N / Looman, Caspar W N / Bosschaart, Adriaan N / Teeuw, Arianne H / Moll, Henriëtte A / de Koning, Harry J

    Pediatrics

    2012  Volume 130, Issue 3, Page(s) 457–464

    Abstract: Objective: Although systematic screening for child abuse of children presenting at emergency departments might increase the detection rate, studies to support this are scarce. This study investigates whether introducing screening, and training of ... ...

    Abstract Objective: Although systematic screening for child abuse of children presenting at emergency departments might increase the detection rate, studies to support this are scarce. This study investigates whether introducing screening, and training of emergency department nurses, increases the detection rate of child abuse.
    Methods: In an intervention cohort study, children aged 0 to 18 years visiting the emergency departments of 7 hospitals between February 2008 and December 2009 were enrolled. We developed a screening checklist for child abuse (the "Escape Form") and training sessions for nurses; these were implemented by using an interrupted time-series design. Cases of suspected child abuse were determined by an expert panel using predefined criteria. The effect of the interventions on the screening rate for child abuse was calculated by interrupted time-series analyses and by the odds ratios for detection of child abuse in screened children.
    Results: A total of 104028 children aged 18 years or younger were included. The screening rate increased from 20% in February 2008 to 67% in December 2009. Significant trend changes were observed after training the nurses and after the legal requirement of screening by the Dutch Health Care Inspectorate in 2009. The detection rate in children screened for child abuse was 5 times higher than that in children not screened (0.5% vs 0.1%, P < .001).
    Conclusions: These results indicate that systematic screening for child abuse in emergency departments is effective in increasing the detection of suspected child abuse. Both a legal requirement and staff training are recommended to significantly increase the extent of screening.
    MeSH term(s) Adolescent ; Checklist ; Child ; Child Abuse/diagnosis ; Child, Preschool ; Emergency Nursing/education ; Emergency Service, Hospital ; Female ; Humans ; Infant ; Male ; Netherlands
    Language English
    Publishing date 2012-09
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2011-3527
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  8. Article: Efficacy of fluticasone propionate on lung function and symptoms in wheezy infants.

    Hofhuis, Ward / van der Wiel, Els C / Nieuwhof, Eveline M / Hop, Wim C J / Affourtit, Marjo J / Smit, Frank J / Vaessen-Verberne, Anja A P H / Versteegh, Florens G A / de Jongste, Johan C / Merkus, Peter J F M

    American journal of respiratory and critical care medicine

    2005  Volume 171, Issue 4, Page(s) 328–333

    Abstract: The role of inhaled corticosteroids in the treatment of recurrent or persistent wheeze in infancy remains unclear. We evaluated the effect of 3 months of treatment with inhaled fluticasone propionate, 200 microg daily (FP200), on lung function and ... ...

    Abstract The role of inhaled corticosteroids in the treatment of recurrent or persistent wheeze in infancy remains unclear. We evaluated the effect of 3 months of treatment with inhaled fluticasone propionate, 200 microg daily (FP200), on lung function and symptom scores in wheezy infants. Moreover, we evaluated whether infants with atopy and/or eczema respond better to FP200 as compared with non-atopic infants. Forced expiratory flow (Vmax(FRC)) was measured at baseline and after treatment. Sixty-five infants were randomized to receive FP200 or placebo, and 62 infants (mean age, 11.3 months) completed the study. Mean Vmax(FRC), expressed as a Z score, was significantly below normal at baseline and after treatment in both groups. The change from baseline of Vmax(FRC) was not different between the two treatment arms. After 6 weeks of treatment, and not after 13 weeks, the FP200 group had a significantly higher percentage of symptom-free days and a significant reduction in mean daily cough score compared with placebo. Separate analysis of treatment effect in infants with atopy or eczema showed no effect modification. We conclude that in wheezy infants, after 3 months of treatment with fluticasone, there was no improvement in lung function and no reduction in respiratory symptoms compared with placebo.
    MeSH term(s) Administration, Inhalation ; Androstadienes/administration & dosage ; Bronchodilator Agents/administration & dosage ; Child, Preschool ; Dermatitis, Atopic/complications ; Dermatitis, Atopic/drug therapy ; Double-Blind Method ; Eczema/complications ; Eczema/drug therapy ; Female ; Fluticasone ; Forced Expiratory Volume/drug effects ; Humans ; Immunoglobulin E/blood ; Infant ; Lung/drug effects ; Lung/physiopathology ; Male ; Respiratory Function Tests/methods ; Respiratory Sounds/drug effects ; Respiratory Sounds/etiology ; Respiratory Sounds/immunology ; Treatment Outcome
    Chemical Substances Androstadienes ; Bronchodilator Agents ; Immunoglobulin E (37341-29-0) ; Fluticasone (CUT2W21N7U)
    Language English
    Publishing date 2005-02-15
    Publishing country United States
    Document type Clinical Trial ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 1180953-x
    ISSN 1535-4970 ; 1073-449X ; 0003-0805
    ISSN (online) 1535-4970
    ISSN 1073-449X ; 0003-0805
    DOI 10.1164/rccm.200402-227OC
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