Child Abuse Inventory at Emergency Rooms (CHAIN-ER); Detection of Child Abuse at Emergency Rooms in Utrecht (the Netherlands): effective?

Child abuse is a significant public health problem. The prevalence of child
abuse in the Netherlands is estimated to be 107.200 cases in the year 2005.
Only a small amount of these cases shows up at an emergency department.
Detection of child abuse at an emergency department seems to be difficult.
After the introduction of a standardized registration form (Sputovamo) the
number of suspected cases of child abuse increased. Nevertheless, the number of
cases caught at an emergency department is only part of the actual occurance:
the positive predictive value of the Sputovamo form for child abuse remains
low. Better signaling procedures will result in more accurate diagnosed cases
and thereby in more adequate treatment of children suffering from child abuse.
This study is designed to investigate the effectiveness of several signaling
procedures in the detection of child abuse an emergency departments in the
Netherlands.

1. to provide data in children presenting with physical injury at EDs on the
predictive value of Sputovamo
2. to address the added predictive value of early phase inquiry with other
health care providers in establishing a diagnosis of child abuse

CHAIN-ER is a multi-centre, cross-sectional study with one year diagnostic
folluw-up.

A number of 3600 children, age under 7 year, which show up at four emergency
departments in the Utrecht region will undergo several screening methods.
Sputovamo will be filled out by trained ED-workers and child abuse risk factors
will be identified by parental questionnaires and by exchanging information
between professionals. Since a gold standard is lacking, an expert panel will
decide on diagnosis after follow-up.
To remove judicial obstacles concerning exchange of information, a convention
between all parties involved is made.

no burden and risks associated with participation