PedHITSS: A screening tool to detect childhood abuse in clinical settings.

Amir Shakil, Philip G Day, Jessica Chu, Sarah B Woods, Kate Bridges 


Background and objectives: Though child abuse is prevalent and detrimental, health care providers fail to screen for abuse at sufficient rates to detect or preempt events. Current child abuse screening tools lack brevity and usefulness in clinical settings. To validate the Pediatric Hurt-Insult-Threaten-Scream-Sex (PedHITSS) screening tool, a 5-item questionnaire designed to detect and prompt provider investigation into child abuse in clinical settings, the PedHITSS was compared to the Conflict Tactics Scale: Parent-Child Version (CTSPC) screening measure.

Methods: Participants included 422 pediatric patients (n=242 nonabused; n=180 abused subsample) recruited from an ambulatory care setting, a medical center at-risk referral clinic, or homeless shelter clinic. Parents were asked to complete a cross-sectional survey, including PedHITSS and CTSPC questionnaires. Concurrent validity of PedHITSS was tested with 242 participants identified as nonabused. Construct validity was assessed with 180 participants previously identified as victims of child abuse.

Results: Concurrent validity between the CTSPC and PedHITSS was strong, rs=.70 (P<.01). Sensitivity and specificity for correctly identifying abuse victims (≤12 years) was optimal at a cutpoint of one or greater. There was no significant difference in sensitivity and specificity of HITSS and CTSPC in correctly identifying victims of child abuse.

Conclusions: This study indicates that PedHITSS performs as well as CTSPC in identifying and differentiating victims and nonvictims of child abuse. PedHITSS allows health care providers to confidently screen and report suspected cases of child abuse and serves as a mechanism to confirm abuse status through validated means.

This article was featured in the October 25, 2022, Lunch and Learn discussion


  • The national rounded number of children who received a child protective services investigation response or alternative response decreased from 3,476,000 for federal fiscal year (FFY) 2019 to 3,145,000 for FFY 2020.
  • Comparing the national number of victims from FFY 2019 (656,000) to the national rounded number of victims in 2020 (618,000) also shows a decrease.
  • The FFY 2020 data show three-quarters (76.1%) of victims are neglected, 16.5 percent are physically abused, 9.4 percent are sexually abused, and 0.2 percent are sex trafficked.
  • The national estimate of victims who died from abuse and neglect decreased from 1,830 for FFY 2019 to 1,750 for FFY 2020. The rate of child fatalities also decreased from 2.48 per 100,000 children in the population to 2.38 per 100,000 children in the population.
  • There is no comprehensive tool that can assess all forms of child abuse and neglect

Source: U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2022). Child Maltreatment 2020. Available from


  • The goal of the project was to develop a validated, short child abuse screening tool to identify and accurately screen childhood physical and sexual abuse in clinical settings. The Pediatric Hurt, Insult, Threaten, Scream, Sex (PedHITSS) is a 5-item, validated screening tool intended for clinical settings. The tool screens for physical, psychological, verbal, and sexual abuse but not for neglect.
  • PedHITSS performs as well as the gold-standard, The Conflict Tactics Scales, Parent-Child Version (CTSPC), but without the complex scoring and time intensiveness
  • Limitations: social desirability bias (i.e., a tendency for respondents to respond in a way that is viewed favorably by others), parent/guardian completion, doesn’t assess neglect, and inability to track follow-up of participants
  • There was a discussion about how often physicians are threatened over issues of reporting child abuse.
  • The hope is that you could use the tool for any patient. It could be another standard screener, regardless of what patient comes into the clinic.

The findings of the study suggest that PedHITSS is a valid and reliable tool to screen for physical, psychological, verbal and sexual abuse in children ages 12 years and under in clinical settings

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