The impact of a management protocol on the outcomes of child abuse in hospitalized children in Hong Kong

• Published in: Child abuse & neglect 2006-08, Vol.30 (8), p.909-917
• Main Authors: Lee, Anselm C.W., Li, C.H., So, K.T.
• Format: Article
• Language: English
• Subjects: Abuse; Adolescent; Biological and medical sciences; Case management; Case Records; Child; Child Abuse; Child abuse & neglect; Child Abuse - classification; Child Abuse - statistics & numerical data; Child, Preschool; Children; China; Clinical outcomes; Clinical protocols; Disease management; Diseases; Evaluation Methods; Female; Foreign Countries; Hong Kong; Hong Kong - epidemiology; Hospitalization; Hospitalization - statistics & numerical data; Hospitalized Children; Hospitals; Humans; Infant; Institution therapy. Inpatient treatment; Interdisciplinary communication; Length of Stay - trends; Male; Medical Care Evaluation; Medical sciences; Outcomes of Treatment; Patient care team; Patient Care Team - organization & administration; Program Implementation; Protocol; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Radiology; Registries; Retrospective Studies; Review (Reexamination); Substance Abuse; Surveys; Treatments; Tropical medicine
• ISSN: 0145-2134; 1873-7757
• DOI: 10.1016/j.chiabu.2006.03.003

To study the outcomes of children hospitalized for suspected child abuse before and after the implementation of a management protocol in a hospital in Hong Kong. Two 2-year periods before (1994–1995) and after (2002–2003) the implementation of the protocol in 1998. This is a retrospective hospital chart review in which the patients’ characteristics, the use of laboratory and radiological examination, abuse substantiation and official registrations are compared between the two study periods. There were 109 and 320 patients admitted for evaluation of child abuse for the periods 1994–1995 and 2002–2003, respectively. Children in both periods were similar in sex ratio, proportion of severe forms of child abuse, rates of abuse substantiation and inclusion in the Child Protection Registry. After the implementation of a management protocol, there has been a significant drop in the proportion of children subjected to investigations such as blood counts (86% vs. 16%, p < .001), clotting study (75% vs. 9%, p < .001), and skeletal survey (78% vs. 6%, p < .001). The average length of hospital stay also dropped from 15.3 days to 6.1 days ( p < .001). There has been an almost threefold rise in the number of child abuse cases handled at the hospital during the 10-year interval. With the implementation of a management protocol, only a small proportion of children need laboratory investigations or skeletal survey without any drop in abuse substantiation and official registration. The length of hospital stay has also been significantly reduced. Étudier des enfants qui ont été hospitalisés dans un hôpital de Hong Kong pour cause possible de maltraitance afin de connaître les effets d’un protocole hospitalier élaboré en 1998 pour gérer ce type de cas. L’étude a eu deux phases d’une durée de deux ans chacune: pré-protocole (1994–95) et post-protocole (2002–2003). On a mené une revue rétrospective des dossiers hospitaliers pour comparer les caractéristiques des patients, le recours à des examens radiologiques et de laboratoire, une recherche des preuves de maltraitance et une inscription officielle. Pour chacune des périodes respectives, 109 et 320 enfants ont été admis pour une évaluation de maltraitance. Les enfants dans les deux groupes étaient semblables au point de vue de la distribution filles/garçons, de la proportion des cas graves, du taux de maltraitance prouvée et de l’inscription dans le registre de la protection de l’enfance. Suite à l’implantation du protocole, on