PT  - JOURNAL ARTICLE
AU  - Rick Robert van Rijn
AU  - Marjo J Affourtit
AU  - Wouter A Karst
AU  - Mascha Kamphuis
AU  - Leonie C de Bock
AU  - Elise van de Putte
ED  - ,
TI  - Implementation of the Dutch expertise centre for child abuse: descriptive data from the first 4 years
AID  - 10.1136/bmjopen-2019-031008
DP  - 2019 Aug 01
TA  - BMJ Open
PG  - e031008
VI  - 9
IP  - 8
4099  - http://bmjopen.bmj.com/content/9/8/e031008.short
4100  - http://bmjopen.bmj.com/content/9/8/e031008.full
SO  - BMJ Open2019 Aug 01; 9
AB  - 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.