A simple screening tool gave emergency department staff confidence in identifying at-risk children, writes Dr Marshall Makate from the School of Population Health at Curtin University
Paediatric physical abuse is tragic and heartbreaking. Emergency departments (EDs) are often the first point of contact with the health system for children with non-accidental injuries.
Only some cases are identified early and the consequences of missing these can be devastating.
Undetected abuse can lead to repeated harm, long-term trauma, and even death. ED staff often face difficult decisions with limited time and information, making it essential to have tools that help them recognise when a child may be at risk.
Recent research in a rural Australian hospital tested a simple screening tool and education program to help staff recognise possible abuse. The results show that small changes can make a big difference in child safety, if adequately resourced.
The problem we face
In Australia’s busy hospitals, missing the warning signs of possible non-accidental injury could mean discharging patients back to an unsafe environment.
Non-verbal children cannot explain their history, so subtle red flag signs and patterns for staff to recognise are important. Specific bone injuries, unexplained bruising, historical inconsistencies with a child’s observed milestones or an unreasonable delay to seek care can all be subtle signs that staff need to be aware of when assessing paediatric injuries, burns and poisonings.
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Without tools and training, we may not always know when or how to act. This is particularly true in rural hospitals, where resources may be limited. In these settings, there may be fewer paediatricians and staff must rely heavily on their clinical judgment.
A simple screening tool
Researchers from Curtin University introduced a screening tool to help clinicians assess potential physical abuse cases. The tool used an abridged version of a checklist developed at Perth Children’s Hospital for all paediatric patients presenting with injuries, burns or poisonings.
The goal was to identify and document red flags so clinicians could take the next steps suggested by the tool, such as making a referral to child protection services.
The research was supported by local leadership who funded regular safety net multidisciplinary team meetings, ensuring no cases were missed. Evidence was triangulated with multiple sources to confirm concerns for physical abuse.
Over 16 months, 1,469 cases were studied before and after the tool was introduced. The results were striking:
- Better documentation – doctors were almost eight times more likely to record detailed notes about injuries, making it easier to track concerns over time
- Cases less likely to be missed – cases that needed further investigation were five times more likely to be referred to child protection services
- Fewer unnecessary hospital admissions – doctors felt more confident in their decisions, ensuring that children received the right care without unnecessary hospital stays. Children were less likely to be admitted
- No increase in re-presentations – the number of children returning to the hospital within 30 days stayed about the same.
One of the most important findings was that the tool helped guide medical decision-making without overwhelming the system. ED staff felt more confident in identifying children at risk, knowing they had a structured process to follow.
The future
This study reminds us that when combined with whole-of-staff education, a simple, evidence-based tool can improve child safety.
The project highlighted the need for ongoing training and support for ED staff, who play an important role in protecting Western Australian children. Additional resources and inter-agency communication would help strengthen the impact of this project.
EDs have a unique opportunity to prevent harm from paediatric physical abuse. A well-designed screening tool, combined with training and support, can improve outcomes.
Every child in the ED deserves to be discharged to a safe environment. If we want to protect children, we must give ED staff the tools and resources they need to act with confidence.
ED: Dr Marshall Makate is a co-author of the study How useful was a paediatric physical abuse screening project in a rural Australian emergency department? published in Emergency Medicine Australasia.
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