Risk factors and physical signs of child abuse in hospitalized children in Taiwan

• The misdiagnosis and under-diagnosis of child abuse in Taiwan is emphasized.
• Young age and prematurity of children are risk factors for child abuse.
• A standardized screening tool with abuse-specific physical signs items is crucial.

PurposeThis study used the Criteria for Distinguishing Abuse from Accidents Chinese version (CDAA-C) to determine cases of child abuse, undetermined intent, and unintentional injury, and compared risk factors and injury profiles among hospitalized children in Taiwan.DesignA retrospective chart review study.MethodsWe selected children aged 0–3 who were hospitalized with a discharge diagnosis of injury or child maltreatment in a medical center in southern Taiwan between 2007 and 2009. The CDAA-C was used to collect children's demographics and injury types and to determine the intent of injury. Children's charts with records and notes of admission, surgery and emergency care were reviewed and analyzed.ResultsAmong 157 eligible cases, the CDAA-C identified 13 child abuse cases including additional 8 victims who were not previously coded in ICD-9-CM. Most abused children suffered from brain injuries, had ≥ 2 in jury incidents, and had a misdiagnosis in the previous visit. Abused children were younger and more likely to be born premature.ConclusionsThis study highlighted the under-diagnosis of child abuse in Taiwan. An easy-to-use standardized screening tool for child abuse in Taiwan is needed.