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Implementation of the Dutch expertise centre for child abuse: descriptive data from the first 4 years
  1. Rick Robert van Rijn1,2,
  2. Marjo J Affourtit3,
  3. Wouter A Karst2,
  4. Mascha Kamphuis4,
  5. Leonie C de Bock4,
  6. Elise van de Putte5
  7. on behalf of the Dutch Expertise Centre for Child Abuse Study Group
    1. 1 Radiology, Emma Children's hospital, Academic Medical Center, Amsterdam, The Netherlands
    2. 2 Forensic Medicine, Nederlands Forensisch Instituut, Den Haag, The Netherlands
    3. 3 Pediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
    4. 4 Dutch Expertise Center for Child Abuse, Utrecht, The Netherlands
    5. 5 General Paediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
    1. Correspondence to Dr Rick Robert van Rijn; r.r.vanrijn{at}


    Objective 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’ theorem and uses likelihood ratios in their conclusions.

    Design We present the implementation process of DECCA and cross-sectional data of the first 4 years.

    Participants 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.

    Results 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 day to 20 years). 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.

    Conclusion 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.

    • child protection child abuse forensic medicine

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    • Collaborators Collaborators of the Dutch Expertise Centre for Child Abuse Study Group are:Department of Forensic Medicine, Netherlands Forensic Institute, the Hague, the Netherlands. Collaborators:Rob A.C. BiloHuub G.T. NijsHeike C. TerlingenSelina de VriesNicole L. van Woerden Department of Paediatrics, Emma Children’s Hospital—Amsterdam UMC, University of Amsterdam, the Netherlands, Collaborators:Leonie van der Berg Annemarie C.M. van BellegemMachtelt BoumanMarie-Louise H. LoosAnika S. SmeijersAriane H. TeeuwDepartment of Paediatrics, Sophia Children’s Hospital—ErasmusMC, Rotterdam, the Netherlands. Collaborators:Patrycja J. PuimanDepartment of Paediatrics, Wilhelmina Children’s Hospital—UMC Utrecht, Utrecht, the Netherlands. Collaborators:Frederique M.C. van BerkestijnFemke KambergSanne L. NijhofJopje M. RuskampIngrid M.B. Russel-KampschoerMaartje SchoutenKarlijn SijstermansSaskia A.A. Wolt-Plompen.

    • Contributors RRvR collected data, carried out the initial analyses and drafted the initial and revised manuscript, and reviewed and revised the manuscript. MJA designed the data collection instruments and critically reviewed the manuscript. WAK designed the data collection instruments and critically reviewed the manuscript. MK carried out the secondary analyses, and drafted the revised manuscript, and critically reviewed and revised the manuscript. LCdB collected data, carried out the secondary analyses and critically reviewed the manuscript. EvdP designed the data collection instruments and coordinated and supervised data collection, and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

    • Funding The Dutch Expertise Centre for Child Abuse is supported by grants from Stichting Kinderpostzegels, Nationale Postcode Loterij, Janivo Stichting, SOD and Fie van der Hoop fonds and governmental support from the Ministry of Health, Welfare and Sport.

    • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The internal review board of the University Medical Centre Utrecht, where DECCA has a postal address, issued a waiver for the documentation of consent and approved the use of an anonymised database.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request. No data are available.