LAUSR

Aims Around 2 million ED attendances per year are related to physical abuse. It is estimated that up to 70% of children who die from abuse had attended an ED previously. Although it is accepted that EDs emphasise the importance in screening for child abuse, a specific evidence based instrument has been lacking. The ESCAPE tool was developed and tested in Dutch hospitals, but has not been validated elsewhere. Particularly in specialist Paediatric EDs, there is concern that the tool lacks sensitivity. This study aimed to evaluate the impact of the ESCAPE tool on safeguarding referrals and estimate the sensitivity of the tool. Methods A controlled prospective evaluation was undertaken over a 3 month period with a historical control in the same period of the previous year. All children attending the ED during the study period were included. Data on tool completion, safeguarding and paediatric liaison referrals were collected. Descriptive analysis was undertaken. The Mann-Whitney test was used for between-group comparison. Significance was set at 0.05. Results For the study period, 14 574 children attended the ED, with an 86% (12534) tool completion rate. Junior clinicians had the highest completion rate (both for Medical/Trauma presentations), with middle grade clinicians completing a higher proportion of Trauma than Medical cases. The table, table 1 shows the impact of the tool on referral activity.Abstract G329(P) Table 1 Historical Control Study Period p-value ED Attendances 14 341 14 574 Paediatric Liaison referrals 156 175 ns Safeguarding referrals 66 67 ns Two cases which screened negative on the ESCAPE tool were nonetheless (appropriately) referred by the assessing clinicians. At follow-up, there was no significant increase in the number of safeguarding plans made in the subsequent 3 months. Conclusions The completion rate (86%) was higher than in the original Dutch study (80%); therefore a reasonable assumption is that clinicians find the tool user-friendly and acceptable. Completion rate was higher amongst the more junior members of the team which is appropriate, since the tool is aimed at highlighting safeguarding concerns which are more likely to be missed by inexperienced clinicians. There was a non-significant trend to higher Paediatric liaison referral rates, and the effect of this (if any) on service workload warrants exploration. The tool should supplement rather than supercede clinician concern.