PAP6 – Concerning Presentations
EM Curriculum: (click to view)
Child abuse is a serious problem but can be difficult to detect. Children who sustain injuries due to abuse are likely to present at an Emergency Department. The incidence of abuse presenting to EDs has been reported to be as high as 10%, however the detection rate has been reported to be a mere 0.1% . It is vital that as emergency physicians we consider abuse as a cause of a number of presentations presenting to the ED.
Approximately 2 million children present to an Emergency Department every year in the UK due to injury . Obviously there is potentially a large cohort of abused children within that number and we need to consider non accidental injury in these patients, particularly in younger children. 80% of abused children with fractures are under 18 months of age, whereas 85% of accidental fractures occur in those over 5 years .
In 2011 Radford et al interviewed young adults and children aged 11-17 years. They found that 25.3% of young adults and 18.6% of 11-17 year olds had been severely maltreated in childhood.
22.9% of children aged 11-17 who were physically hurt by a parent of guardian did not tell anyone else about it, this figure rose to 34% of those who experienced contact sexual abuse by an adult and 82.7% of those experienced contact sexual abuse by a peer.
As emergency physicians we are highly likely to come across children experiencing abuse during our clinical practice. It is therefore vitally important that we know the signs and symptoms of different forms of child abuse and how these may present in our patients.
Louwers et al. Screening for child abuse at emergency department: a systematic review. Arch Dis Child 2010;95:214
Benger JR, Pearce V. Simple intervention to improve detection of child abuse in emergency departments. BMJ 2002;324:780
- Core Info: http://www.core-info.cardiff.ac.uk
LEARNING OUTCOMES FROM COMPLETING THE TASKS
Understand the different forms of abuse that can occur in childhood.
Know the symptoms and signs of abuse and how they may present in children attending the Emergency Department.
Recognise risk factors for abuse in children.
Document clinical findings, concerns and conversations with other parties in cases of suspected child maltreatment.
Have an understanding of the roles of non-healthcare agencies in safeguarding children.
LEARNING OUTCOMES FROM FACE-TO-FACE TEACHING
Formulate a management plan for cases where safeguarding issues have been raised.
Share information appropriately with other agencies involved in safeguarding children.
Discuss safeguarding concerns with a child's carers where appropriate.
Now make sure you are familiarised with the following ED protocols related to chest pain, some of which have been developed in conjunction with NICE guidelines. Please use them on every relevant ED patient and seek senior ED advice if needed.
Task 1: Learning From Child Death
Duration: 5 mins
This short video summaries Dr Rowlands RCEM15 (Manchester) talk on learning from the death of a child.
Task 2: Child Protection Levels 1-3
These modules require access to the learning for health platform (this is free for those who work in the NHS)...
Duration: 3 hours
Task 3: Injury Patterns Suggesting NAI
Duration: 8 mins
This video summarises some of the injury patterns and features that children may present with that are high risk fro NAI.
Here are some extra resources to review if you want more information:
Key documents and legislation underpinning safeguarding practice in the UK
A helpful review covering consent, capacity and parental responsibility.
This is a great website run by a group based at Cardiff University who systematically review world literature on the recognition and investigation of suspected child abuse/maltreatment.
This is a useful review article covering the assessment of different types of physical injuries that may be inflicted on children.
An interesting article and box 2 on page 7 highlights the probability of abuse from several fracture types.
Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: