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An audit of emergency medicine responses to children injured in violence
  1. Jonathan Shepherd1,
  2. David Tuthill2,
  3. Bethan Parry1,
  4. Hugo Dowd3
  1. 1Violence Research Group, Cardiff University, Cardiff, UK
  2. 2Department of Paediatrics, Cardiff and Vale NHS Trust, Cardiff, UK
  3. 3Emergency Unit, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Professor Jonathan P Shepherd, Oral Surgery, Medicine and Pathology Audit Group, Dental School and Hospital, Heath Park, Cardiff CF14 4XY, UK; shepherdjp{at}


Aim To audit emergency department (ED) responses to violence in which children are injured in violence in a European capital city.

Methods A prospective survey of children (aged <16 years) was conducted in Cardiff's only ED using ED software adapted for this purpose. All clinical records were scrutinised for evidence of discussion with and referral to agencies concerned with child protection.

Results 123 children reportedly injured in violence (92 boys) were treated in 2004, six aged 5–9  years; one under 5 years. Overall, 24 (19%) incidents had been reported to the police prior to ED arrival. Only four (3%) prompted documented referral or discussions with other agencies while in the ED. 78% prompted no action apart from treatment of injuries. 13 (10%) children had fractures or were admitted, but only two of these incidents had been drawn to police attention. Only five (4%) were injured at home; a large majority were injured in the street or at school with fists or feet (12 with a weapon) by other children or adults.

Conclusions In this audit, most violence in which children were injured took place in schools and in the street. For children of secondary school age, ED treatment rarely prompted referral or discussion with agencies responsible for child safety. Particularly since youth and child violence are major national issues, policy and practice in this area were developed and built on disclosure of all such cases to a single referral point in the local authority education department.

  • Audit
  • cardiac care, care systems
  • forensic/legal medicine
  • paediatrics, paediatric injury
  • violence, non accidental

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  • Competing interests None.

  • Ethics approval This is a clinical audit approved through clinical governance procedures by the Cardiff and Vale NHS Trust.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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