{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T23:07:40Z","timestamp":1765667260409,"version":"3.46.0"},"reference-count":22,"publisher":"BMJ","issue":"8","funder":[{"name":"Stichting Kinderpostzegels"},{"name":"Nationale Postcode Loterij"},{"DOI":"10.13039\/501100002999","name":"Ministerie van Volksgezondheid, Welzijn en Sport","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002999","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010316","name":"Janivo Stichting","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010316","id-type":"DOI","asserted-by":"crossref"}]},{"name":"SOD & Fie van der Hoop fonds"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,7,25]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Combined paediatric and forensic medical expertise to interpret physical findings is not available in Dutch healthcare facilities. The Dutch Expertise Centre for Child Abuse (DECCA) was founded in the conviction that this combination is essential in assessing potential physical child abuse. DECCA is a collaboration between the three paediatric hospitals and the Netherlands Forensic Institute. DECCA works with Bayes\u2019 theorem and uses likelihood ratios in their conclusions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We present the implementation process of DECCA and cross-sectional data of the first 4\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Between 14 December 2014 and 31 December 2018, a total of 761 advisory requests were referred, all of which were included in this study. An advisee evaluation over the year 2015 was performed using a self-constructed survey to gain insight in the first experiences with DECCA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>761 cases were included, 381 (50.1%) boys and 361 (47.4%) girls (19 cases (2.5%) sex undisclosed). Median age was 1.5 years (range 1\u2009day to 20\u2009years). Paediatricians (53.1%) and child safeguarding doctors (21.9%) most frequently contacted DECCA. The two most common reasons for referral were presence of injury\/skin lesions (n=592) and clinical history inconsistent with findings (n=145). The most common injuries were bruises (264) and non-skull fractures (166). Outcome of DECCA evaluation was almost certainly no or improbable child abuse in 35.7%; child abuse likely or almost certain in 24.3%, and unclear in 12%. The advisee evaluations (response rate 50%) showed that 93% experienced added value and that 100% were (very) satisfied with the advice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Data show growing interest in the expertise of DECCA through the years. DECCA seems to be a valuable addition to Dutch child protection, since advisee value the service and outcome of DECCA evaluations. In almost half of the cases, DECCA concluded that child abuse could not be substantiated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-031008","type":"journal-article","created":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T05:18:11Z","timestamp":1566451091000},"page":"e031008","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Implementation of the Dutch expertise centre for child abuse: descriptive data from the first 4 years"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8876-6515","authenticated-orcid":false,"given":"Rick Robert","family":"van Rijn","sequence":"first","affiliation":[{"name":"Radiology, Emma Children's hospital, Academic Medical Center, Amsterdam, The Netherlands"},{"name":"Forensic Medicine, Nederlands Forensisch Instituut, Den Haag, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marjo J","family":"Affourtit","sequence":"additional","affiliation":[{"name":"Pediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wouter A","family":"Karst","sequence":"additional","affiliation":[{"name":"Forensic Medicine, Nederlands Forensisch Instituut, Den Haag, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mascha","family":"Kamphuis","sequence":"additional","affiliation":[{"name":"Dutch Expertise Center for Child Abuse, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonie C","family":"de Bock","sequence":"additional","affiliation":[{"name":"Dutch Expertise Center for Child Abuse, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elise","family":"van de Putte","sequence":"additional","affiliation":[{"name":"General Paediatrics, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,21]]},"reference":[{"key":"2025120618033886000_9.8.e031008.1","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0749-3797(98)00017-8","article-title":"Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study","volume":"14","author":"Felitti","year":"1998","journal-title":"Am J PrevMed"},{"key":"2025120618033886000_9.8.e031008.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61706-7"},{"key":"2025120618033886000_9.8.e031008.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0145-2134(97)00036-7"},{"key":"2025120618033886000_9.8.e031008.4","unstructured":"Gelles RJ , Perlman S . Estimated annual cost of child abuse and neglect. Chicago IL: Prevent Child Abuse America, 2012."},{"key":"2025120618033886000_9.8.e031008.5","unstructured":"Royal Dutch Medical Association . KNMG-meldcode kindermishandeling en huiselijk geweld 2018. Available: https:\/\/www.knmg.nl\/advies-richtlijnen\/knmg-publicaties\/meldcode-kindermishandeling-en-huiselijk-geweld-1.htm"},{"key":"2025120618033886000_9.8.e031008.6","unstructured":"Who regional office for Europe. European report on preventing child maltreatment. In: Sethi D, Bellis M, Hughes K, et al., eds 2013."},{"key":"2025120618033886000_9.8.e031008.7","unstructured":"Kindermishandeling LEC . Available: www.leck.nu [Accessed 5-10-2017]."},{"key":"2025120618033886000_9.8.e031008.8","unstructured":"Parliament E . 2018 reform of EU data protection rules, 2018. Available: https:\/\/ec.europa.eu\/commission\/priorities\/justice-and-fundamental-rights\/data-protection\/2018-reform-eu-data-protection-rules_en [Accessed 10-4-2019]."},{"key":"2025120618033886000_9.8.e031008.9","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.chiabu.2015.04.011","article-title":"Child advocacy center multidisciplinary team decision and its association to child protective services outcomes","volume":"46","author":"Brink","year":"2015","journal-title":"Child Abuse Negl"},{"key":"2025120618033886000_9.8.e031008.10","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1177\/000313481708300521","article-title":"Jr. a multidisciplinary child protection team improves the care of Nonaccidental trauma patients","volume":"83","author":"Draus","year":"2017","journal-title":"The American surgeon"},{"key":"2025120618033886000_9.8.e031008.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2006.12.010"},{"key":"2025120618033886000_9.8.e031008.12","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1111\/apa.13779","article-title":"Paediatric approaches to child maltreatment are subject to wide organisational variations across Europe","volume":"106","author":"Otterman","year":"2017","journal-title":"Acta Paediatr"},{"key":"2025120618033886000_9.8.e031008.13","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e31817de11d"},{"key":"2025120618033886000_9.8.e031008.14","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.chiabu.2012.01.004","article-title":"Diagnostic accuracy in child sexual abuse medical evaluation: role of experience, training, and expert case review","volume":"36","author":"Adams","year":"2012","journal-title":"Child Abuse Negl"},{"key":"2025120618033886000_9.8.e031008.15","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/j.1939-3938.2011.01131.x","article-title":"Pediatric sexual assault nurse examiner care: trace forensic evidence, ano-genital injury, and judicial outcomes","volume":"8","author":"Hornor","year":"2012","journal-title":"J Forensic Nurs"},{"key":"2025120618033886000_9.8.e031008.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2011.06.005"},{"key":"2025120618033886000_9.8.e031008.17","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1111\/apa.13735","article-title":"Assessments carried out by a child abuse and neglect team in an Amsterdam teaching hospital led to interventions in most of the reported cases","volume":"106","author":"Teeuw","year":"2017","journal-title":"Acta Paediatr"},{"key":"2025120618033886000_9.8.e031008.18","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-2485"},{"key":"2025120618033886000_9.8.e031008.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2011.08.005"},{"key":"2025120618033886000_9.8.e031008.20","doi-asserted-by":"crossref","first-page":"21","DOI":"10.3109\/02813432.2015.1001941","article-title":"Facing suspected child abuse \u2013 what keeps Swedish general practitioners from reporting to child protective services?","volume":"33","author":"Talsma","year":"2015","journal-title":"Scand J Prim Health Care"},{"key":"2025120618033886000_9.8.e031008.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0145-2134(00)00199-X"},{"key":"2025120618033886000_9.8.e031008.22","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-0432"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-031008","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T02:03:50Z","timestamp":1765073030000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-031008"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8]]},"references-count":22,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,8,21]]},"published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1136\/bmjopen-2019-031008"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-031008","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2019,8]]}}}