Subject(s)
Adrenal Cortex Hormones/administration & dosage , Dermatitis, Atopic/therapy , Emollients/administration & dosage , Home Nursing , Parents , Administration, Topical , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Patient Education as Topic , Surveys and QuestionnairesABSTRACT
OBJECTIVE: The aim of our diagnostic accuracy study Child Abuse Inventory at Emergency Rooms (CHAIN-ER) was to establish whether a widely used checklist accurately detects or excludes physical abuse among children presenting to ERs with physical injury. DESIGN: A large multicentre study with a 6-month follow-up in 4 ERs in The Netherlands. METHOD: Participants were 4290 children aged 0-7 years, attending the ER because of physical injury. All children were systematically tested with an easy-to-use child abuse checklist (index test). A national expert panel (reference standard) retrospectively assessed all children with positive screens and a 15% random sample of the children with negative screens for physical abuse, using additional information, namely, an injury history taken by a paediatrician, information provided by the general practitioner, youth doctor and social services by structured questionnaires, and 6-month follow-up information. Our main outcome measure was physical child abuse; secondary outcome measure was injury due to neglect and need for help. RESULTS: 4253/4290 (99%) parents agreed to follow-up. At a prevalence of 0.07% (3/4253) for inflicted injury by expert panel decision, the positive predictive value of the checklist was 0.03 (95% CI 0.006 to 0.085), and the negative predictive value 1.0 (0.994 to 1.0). There was 100% (93 to 100) agreement about inflicted injury in children, with positive screens between the expert panel and child abuse experts. CONCLUSION: Rare cases of inflicted injury among preschool children presenting at ERs for injury are very likely captured by easy-to-use checklists, but at very high false-positive rates. Subsequent assessment by child abuse experts can be safely restricted to children with positive screens at very low risk of missing cases of inflicted injury. Because of the high false positive rate, we do advise careful prior consideration of cost-effectiveness and clinical and societal implications before de novo implementation.
Subject(s)
Child Abuse/diagnosis , Emergency Service, Hospital , Physical Examination/adverse effects , Social Work/methods , Child , Child Abuse/prevention & control , Child Abuse/statistics & numerical data , Child, Preschool , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Netherlands/epidemiology , Parents/psychology , Retrospective Studies , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To evaluate the effectiveness of an electronic learning (e-learning) programme on the performance of nurses in the recognition of child abuse in a simulated case in the Emergency Department (ED). DESIGN: Blinded, randomised controlled trial using pre- and postintervention design. SETTING: The ED of a University Medical Center in the Netherlands. PARTICIPANTS: 38 ED nurses were included, 25 nurses were analysed. INTERVENTION: Half of the participants followed a 2-hour e-learning programme focused on the recognition of child abuse, the others acted as a control group. MAIN OUTCOME MEASUREMENTS: Individual performance during a case-simulated parent interview to detect child abuse and self-reported self-efficacy for the detection of child abuse. Performance on the simulation was scored by an expert panel using a standardised assessment form which was designed to score quantity and quality of the questions posed by the nurse (minimum score 0; maximum score 114). RESULTS: During post-test, nurses in the intervention group performed significantly better during the simulation than the control group, (89 vs 71, 95% CI 2.9 to 33.3), and reported higher self-efficacy (502 vs 447, 95% CI -25.4 to 134.7). Performance in detecting child abuse correlated positively with the self-efficacy score (Spearman correlation 0.387, p value 0.056). Comparing post- and pretest results separately for the intervention and the control group showed a significant increase in performance in the intervention group. CONCLUSION: E-learning improved the performance in case simulations and the self-efficacy of the nurses in the ED in the detection of child abuse. Wider implementation of the e-learning programme to improve the first step in the detection of child abuse is recommended.
Subject(s)
Child Abuse/diagnosis , Computer-Assisted Instruction/methods , Education, Nursing, Continuing/methods , Emergency Nursing/education , Adult , Child , Emergency Service, Hospital , Female , Humans , Internet , Male , Middle Aged , Patient Simulation , Self EfficacyABSTRACT
Ultrasonographic demonstration of periventricular cysts is usually associated with cystic periventricular leucomalacia due to necrosis of periventricular unmyelinated white matter. Cystic spaces with a similar appearance may also arise from prenatal lysis of fetal periventricular matrix tissue, rather than immature white matter. The resultant empty spaces are called "pseudocysts" or germinolytic cysts. Neuropathological studies have shown that germinolytic cysts may arise in Zellweger syndrome (generalized peroxisomal disorder). Here, we report their ultrasonographic demonstration in Zellweger syndrome, emphasizing the potential value of this sign in the diagnosis.
