A preliminary screening instrument for early detection of medical child abuse.

OBJECTIVE The goal of this research was to develop a screening instrument for early identification among hospitalized children of medical child abuse (MCA). METHODS We developed a preliminary screening instrument for the early identification of MCA. Items were chosen based on published characteristics of MCA, including caregiver, patient, and illness information. Each item in the instrument was scored with 1 point if positive. This instrument was tested by reviewing the hospital charts of child protective services-confirmed MCA patients and comparing the results with charts of children with admissions for apnea, vomiting/diarrhea, and seizures who were not diagnosed with MCA. Nineteen cases and 389 controls were used for analysis. We used receiver operating characteristic curves, starting with items most highly associated with MCA in our sample. Predictive values and strengths of association were assessed by using chi2 and Fisher's exact tests, as appropriate. RESULTS From an initial 46 questions, we determined that 26 items showed a statistically significant difference between cases and control patients. From these, an instrument with 15 items maximized the area under the receiver operating characteristic curve, and a score of > or =4 had a sensitivity of 0.947 and a specificity of 0.956 (P<.05) in detecting MCA. CONCLUSIONS This chart review screening instrument identified differences in characteristics of children, caregivers, and illness during hospitalization that may allow for earlier detection of MCA and referral for further assessment to the multidisciplinary team.