Explorations complémentaires face à une situation d’enfant en danger : état des lieux des pratiques en France en 2015

Abstract

Even if there are HAS (French National Health Authority) guidelines on shaken baby syndrome, many other child abuse situations are not included in these recommendations. The aim of this study was to invent the complementary exams in cases of child abuse in France and compare the practice to existing guidelines. This was a multicenter study by email to 128French hospitals (35university hospitals and 93general hospitals) that receives children in emergency and hospitalization settings. Three child abuse clinical situations were included in a clinical case multiple-choice format concerning the further explorations. We described the main results and evaluated their adherence to the HAS protocol for case1. Of 128hospitals surveyed, 104responded, for an 81% response rate, which corresponded to 274doctors. Analysis of the results showed great heterogeneity in practices. The majority of physicians (99%) performed systematic explorations in the situation of physical abuse, while only 27% undertook such exams in situations of serious neglect. The situation of sexual abuse was the most consensual in terms of diagnostic tests for the detection of sexually transmitted diseases, but other types of associated abuse were not sought. In the first case, the HAS guidelines were respected in less than half of the cases for all complementary exams except the eye fundus exam. Abdominal imaging was insufficiently performed (40% of cases). Examinations that were not indicated were still prescribed. Moreover, siblings under 2years of age were examined in only one-third of cases (n=88/274; 32%). Practices were not influenced by the age of the child. This study illustrates the heterogeneity in the use of complementary exams in cases of child abuse in France. Common protocols throughout the country would be useful, standardizing the most relevant exams for potential medical-legal issues, and facilitating exchanges concerning practices between different centers.