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Objective To evaluate the effectiveness of an electronic learning (e-learning) programme on the performance of nurses in the recognition of child abuse in a simulated case in the Emergency Department (ED). Design Blinded, randomised controlled trial using pre- and postintervention design. Setting The ED of a University Medical Center in the Netherlands. Participants 38 ED nurses were included, 25 nurses were analysed. Intervention Half of the participants followed a 2-h e-learning programme focused on the recognition of child abuse, the others acted as a control group. Main outcome measurements Individual performance during a case-simulated parent interview to detect child abuse and self-reported self-efficacy for the detection of child abuse. Performance on the simulation was scored by an expert panel using a standardised assessment form which was designed to score quantity and quality of the questions posed by the nurse (minimum score 0; maximum score 114). Results During post-test, nurses in the intervention group performed significantly better during the simulation than the control group, (89 vs 71, 95% CI 2.9 to 33.3), and reported higher self-efficacy (502 vs 447, 95% CI -25.4 to 134.7). Performance in detecting child abuse correlated positively with the self-efficacy score (Spearman correlation 0.387, p value 0.056). Comparing post- and pretest results separately for the intervention and the control group showed a significant increase in performance in the intervention group. Conclusion E-learning improved the performance in case simulations and the self-efficacy of the nurses in the ED in the detection of child abuse. Wider implementation of the e-learning programme to improve the first step in the detection of child abuse is recommended. Trial registration Protocol registration system of clinicaltrials.gov: NCT00844571. [ABSTRACT FROM AUTHOR]