Maguire Sabine, Mann Mala, John Nia, Ellaway Bev, Sibert Jo R, Kemp Alison M
Department of Child Health, Wales College of Medicine, Cardiff University, Academic Centre, Llandough Hospital, Penarth CF64 2XX, UK.
Child Abuse Negl. 2006 Jul;30(7):739-51. doi: 10.1016/j.chiabu.2005.12.007.
There is a diagnostic dilemma when a child presents with rib fractures after cardiopulmonary resuscitation (CPR) where child abuse is suspected as the cause of collapse. We have performed a systematic review to establish the evidence base for the following questions: (i) Does cardiopulmonary resuscitation cause rib fractures in children? (ii) If so, what are the frequency and characteristics of these fractures that may help to distinguish them from rib fractures caused by physical abuse?
We performed a literature search of original articles, references, textbooks, and conference abstracts, published in any language from 1950 to 1 October 2005. Articles were identified from ASSIA, Caredata, Medline, Ovid Medline in Process, ChildData, CINAHL, Embase, ISI Proceedings, SIGLE, Science Citation Index, Social Science Citation Index, and TRIP databases. We included all studies that addressed rib fractures and CPR in children less than 18 years, and excluded review articles, expert opinion, consensus guidelines, and studies that were significantly methodologically flawed on critical appraisal. Each study underwent two independent reviews (with a third review if there was disagreement). Each reviewer used standardized criteria for study definition, data extraction, and critical appraisal, to determine the quality of the study and to establish if it met the inclusion criteria of this systematic review.
Of the 427 studies reviewed, 6 were included: 1 case control, 4 cross-sectional, and 1 case series. These represent data on 923 children who underwent CPR. Three children sustained rib fractures as a result of resuscitation; all three of these had fractures that were anterior (two mid-clavicular and one costo-chondral). We did not find any child in the literature who had a posterior rib fracture due to CPR. Resuscitation was performed variably by both medical and non-medical personnel.
Rib fractures after cardiopulmonary resuscitation are rare. When they do occur, they are anterior and may be multiple. As the studies performed to date did not use the most sensitive techniques for detecting rib fractures, further prospective studies of children would be valuable to provide additional clarification on this question.
当儿童在心肺复苏（CPR）后出现肋骨骨折且怀疑心脏骤停的原因是虐待儿童时，会存在诊断困境。我们进行了一项系统综述，以建立以下问题的证据基础：（i）心肺复苏会导致儿童肋骨骨折吗？（ii）如果会，这些骨折的频率和特征是什么，可能有助于将它们与身体虐待导致的肋骨骨折区分开来？
我们对1950年至2005年10月1日以任何语言发表的原创文章、参考文献、教科书和会议摘要进行了文献检索。文章从ASSIA、Caredata、Medline、Ovid Medline in Process、ChildData、CINAHL、Embase、ISI Proceedings、SIGLE、科学引文索引、社会科学引文索引和TRIP数据库中识别。我们纳入了所有涉及18岁以下儿童肋骨骨折和心肺复苏的研究，并排除了综述文章、专家意见、共识指南以及在批判性评价中存在重大方法缺陷的研究。每项研究都经过两次独立评审（如果存在分歧则进行第三次评审）。每位评审员使用标准化标准进行研究定义、数据提取和批判性评价，以确定研究质量并确定其是否符合本系统综述的纳入标准。
在审查的427项研究中，纳入了6项：1项病例对照研究、4项横断面研究和1项病例系列研究。这些代表了923名接受心肺复苏儿童的数据。三名儿童因复苏导致肋骨骨折；这三名儿童的骨折均为前部骨折（两根锁骨中线骨折和一根肋软骨骨折）。我们在文献中未发现因心肺复苏导致后肋骨骨折的儿童。医疗人员和非医疗人员进行复苏的方式各不相同。
心肺复苏后肋骨骨折很少见。当确实发生时，它们是前部骨折，可能是多处骨折。由于迄今为止进行的研究未使用检测肋骨骨折最敏感的技术，因此对儿童进行进一步的前瞻性研究对于就此问题提供更多澄清将是有价值的。
