Child Maltreatment in Lebanon: Prevalence, Screening and Upgrade of ESCAPE

Abstract

Child maltreatment is a violation of human rights and includes all forms of abuse against children under 18 years of age. It is the second cause of death in children after accidental trauma and remains an active problem worldwide. In Lebanon, little work is being done nationwide to provide and explain the available screening and reporting tools for child maltreatment. In this study, we assess the diagnostic accuracy of the ESCAPE instrument and its modified version (including one additional question “<i>Did parents/caregivers take adequate measures?</i>”) in screening child maltreatment in emergency departments, and calculate the prevalence of child abuse in Lebanon. The present diagnostic accuracy study is performed over 16 months using a convenience sampling on children under the age of 18 who presented to Lebanese emergency departments. Confirmation of maltreatment by the child protection team was considered as the cornerstone to diagnosis. Screening performance characteristics of ESCAPE and ESCAPE-modified were calculated using GPower v3.1 and SPSS v22 soft wares. 411 children with the mean age of 5.7 years were screened (38% girls). 47 children were suspected victims of child abuse (11.4%). 13 children (3.2%) were confirmed victims of child maltreatment. Sensitivity, specificity, positive and negative predictive values of this test, with 95% confidence intervals, were 100% (82.7 – 100), 91.5% (88.4 – 93.9), 27.7% (16.5 – 41.5), and 100% (99.3 – 100) respectively. The additional question added to ESCAPE did not alter the diagnostic performance of the test but was superior in terms of positive predictive value without losing in terms of negative predictive value. In this study, ESCAPE was proven to be an appropriate screening instrument for identifying children at high risk of child abuse, with excellent accuracy. The additional question of “<i>Did parents/caregivers take adequate measures?</i>” represents a simpler tool with a higher positive predictive value, to be used after a positive ESCAPE screening to help confirm or reject the diagnosis of child maltreatment in case of doubt.