Systematic screening of child abuse in out-of-hours primary care

Child abuse is a serious global health problem. This thesis focused on – improving – the detection of child abuse in the out-of-hours primary care (OOH-PC). The main aim was to assess the diagnostic value of the screening instrument SPUTOVAMO-R2 for child abuse. We found that the detection rate of the SPUTOVAMO-R2 checklist for child abuse is low in the OOH-PC (1.8%), with a high false positive rate. It is possible to reduce the length of the checklist to only two questions (SPUTOVAMO-R3), without compromising the diagnostic value. Furthermore, the use of the SPUTOVAMO-R2 checklist in combination with a screening protocol (flowcharts and reporting code) enhances professional performance of general practitioners when there is a suspicion of child abuse, and also increases their competencies. In addition, it guarantees consistent actions and care for the children with a suspicion of child abuse. Because of the low detection rate and the moderate validity of the checklists for child abuse, it is recommended to use the shortened checklist only as a tool to increase the awareness of child abuse.