Woodman J, Lecky F, Hodes D, Pitt M, Taylor B, Gilbert Ruth
Centre for Evidence-based Child Health and MRC Centre of Epidemiology for Child Health, UCL-Institute of Child Health, London, UK.
Child Care Health Dev. 2010 Mar;36(2):153-64. doi: 10.1111/j.1365-2214.2009.01025.x. Epub 2009 Dec 29.
Screening markers are used in emergency departments (EDs) to identify children who should be assessed for possible physical abuse and neglect. We conducted three systematic reviews evaluating age, repeat attendance and injury type as markers for physical abuse or neglect in injured children attending EDs.
We included studies comparing markers in physically abused or neglected children and non-abused injured children attending ED or hospital. We calculated likelihood ratios (LRs) for age group, repeat attendance and injury type (head injury, bruises, fractures, burns or other). Given the low prevalence of abuse or neglect, we considered that an LR of 10 or more would be clinically useful.
All studies were poor quality. Infancy increased the risk of physical abuse or neglect in severely injured or admitted children (LRs 7.7-13.0, 2 studies) but was not strongly associated in children attending the ED (LR 1.5, 95% CI: 0.9, 2.8; one study). Repeat attendance did not substantially increase the risk of abuse or neglect and may be confounded by chronic disease and socio-economic status (LRs 0.8-3.9, 3 studies). One study showed no evidence that the type of injury substantially increased the risk of physical abuse or neglect in severely injured children.
There was no evidence that any of the markers (infancy, type of injury, repeated attendance) were sufficiently accurate (i.e. LR >or= 10) to screen injured children in the ED to identify those requiring paediatric assessment for possible physical abuse or neglect. Clinicians should be aware that among injured children at ED a high proportion of abused children will present without these characteristics and a high proportion of non-abused children will present with them. Information about age, injury type and repeat attendances should be interpreted in this context.
在急诊科，筛查指标用于识别那些可能遭受身体虐待或忽视的儿童，需要进行评估。我们进行了三项系统评价，评估年龄、再次就诊情况和损伤类型作为急诊科受伤儿童身体虐待或忽视的指标。
我们纳入了比较急诊科或医院中遭受身体虐待或忽视的儿童与未受虐待的受伤儿童的指标的研究。我们计算了年龄组、再次就诊情况和损伤类型（头部损伤、瘀伤、骨折、烧伤或其他）的似然比（LRs）。鉴于虐待或忽视的患病率较低，我们认为似然比为10或更高将具有临床实用性。
所有研究质量都很差。婴儿期增加了重伤或住院儿童遭受身体虐待或忽视的风险（似然比7.7 - 13.0，2项研究），但在急诊科就诊的儿童中相关性不强（似然比1.5，95%置信区间：0.9，2.8；1项研究）。再次就诊并没有实质性增加虐待或忽视的风险，可能受慢性病和社会经济状况的影响（似然比0.8 - 3.9，3项研究）。一项研究表明，没有证据表明损伤类型会大幅增加重伤儿童遭受身体虐待或忽视的风险。
没有证据表明任何指标（婴儿期、损伤类型、再次就诊）足够准确（即似然比≥10），能够在急诊科筛查受伤儿童，以识别那些需要进行儿科评估以确定是否可能遭受身体虐待或忽视的儿童。临床医生应意识到，在急诊科的受伤儿童中，很大一部分受虐待儿童不会表现出这些特征，而很大一部分未受虐待儿童会表现出这些特征。在这种背景下，应解读有关年龄、损伤类型和再次就诊情况的信息。
