{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:25:33Z","timestamp":1753878333611,"version":"3.41.2"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Children with non\u2010accidental injuries have increased risk of future death. There is insufficient evidence for widespread physical abuse screening tool use in the ED. This study assesses the utility of a physical abuse project that includes the implementation of a screening tool with case\u2010matching from multiple sources. It aims to confirm whether risk\u2010screening in a medium\u2010sized rural Australian ED is reliable and will improve outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a 16\u2010month ED retrospective pre\u2010\/post\u2010implementation study of all injury, burn or poisoning cases 16\u2009years and under during a paediatric physical abuse safety project which included a screening tool. Presentations with potential physical abuse were filtered by ICD\u201010 codes and reviewed. Multivariable logistic regression models compared pre\u2010 and post\u2010implementation cases. Analyses examined outcomes, trends and interrogated the screening tool which formed a Clinical Pathway Algorithm (CPA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1469 presentations underwent investigation: 747 pre\u2010implementation and 722 post\u2010implementation. Pearson's <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup> test showed statistically insignificant differences. If tool used, documentation improved (odds ratio [OR] 7.73; 95% confidence interval [CI] 4.91\u201312.18), child protection service referrals increased (OR 5.50; 95% CI 1.82\u201316.61) and hospital admissions decreased (OR 0.42; 95% CI 0.22\u20130.79). Re\u2010presentation rates stayed the same. Increased physical abuse was associated with screening factors including carer behavioural concerns, inadequate supervision, delayed presentation, repeat and unexplained injuries (ORs\/CIs in an accompanying Table 4). Screening tool sensitivity was 62.3% and specificity 79.7%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Implementing this ED paediatric physical abuse project improved safety behaviours and best\u2010practice documentation. The tool improved medical decision making without increased re\u2010presentations. ED clinicians may use similar CPAs to help review safety concerns and facilitate discharge; however, resources are needed to investigate referrals flagged due to false\u2010positive rates.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1742-6723.70000","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T05:14:48Z","timestamp":1738300488000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How useful was a paediatric physical abuse screening project in a rural Australian emergency department?"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2273-7658","authenticated-orcid":false,"given":"John","family":"van Bockxmeer","sequence":"first","affiliation":[{"name":"Emergency Department WA Country Health Service  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lesley","family":"Enzor","sequence":"additional","affiliation":[{"name":"Emergency Department WA Country Health Service  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marshall","family":"Makate","sequence":"additional","affiliation":[{"name":"Curtin School of Population Health Curtin University  Perth Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne","family":"Robinson","sequence":"additional","affiliation":[{"name":"School of Health and Social Development Deakin University Faculty of Health  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"volume-title":"Reporting the Health and Development of Children in Rural and Remote Australia","year":"2017","author":"Arefadib N","key":"e_1_2_10_2_1"},{"volume-title":"Child Protection Australia 2022\u201323","year":"2024","author":"Australian Institute of Health and Welfare","key":"e_1_2_10_3_1"},{"volume-title":"Responding to Child Maltreatment: A Clinical Handbook for Health Professionals","year":"2022","author":"World Health Organization","key":"e_1_2_10_4_1"},{"volume-title":"Australia's Children","year":"2022","author":"Australian Institute of Health and Welfare","key":"e_1_2_10_5_1"},{"key":"e_1_2_10_6_1","first-page":"2","article-title":"Rural health outcomes in Australia: a synthesis","volume":"104","author":"Australian Bureau of Statistics","year":"2013","journal-title":"Can. 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