Maguire Sabine, Mann Mala
Early Years Research Programme, School of Medicine, Cardiff University, Wales, UK.
Evid Based Child Health. 2013 Mar 7;8(2):255-63. doi: 10.1002/ebch.1909.
Dogma has long prevailed regarding the ageing of bruises, and whether certain patterns of bruising are suggestive or diagnostic of child abuse.
We conducted the first Systematic Reviews addressing these two issues, to determine the scientific basis for current clinical practice. There have been seven updates since 2004.
An all language literature search was performed across 13 databases, 1951-2004, using >60 key words, supplemented by 'snowballing' techniques. Quality standards included a novel confirmation of abuse scale. Updates used expanded key words, and a higher standard for confirmation of abuse.
Of 1495 potential studies, only three met the inclusion criteria for ageing of bruises in 2004, confirming that it is inaccurate to do so with the naked eye. This was roundly rejected when first reported, generating a wave of new studies attempting to determine a scientifically valid method to age bruises, none of which are applicable in children yet. Regarding patterns of bruising that may be suggestive or diagnostic of abuse, we included 23 of 167 studies reviewed in 2004, although only 2 were comparative studies. Included studies noted that unintentional bruises occur predominantly on the front of the body, over bony prominences and their presence is directly correlated to the child's level of independent mobility. Bruising patterns in abused children, differed in location (most common site being face, neck, ear, head, trunk, buttocks, arms), and tended to be larger. Updates have included a further 14 studies, including bruising in disabled children, defining distinguishing patterns in severely injured abused and non-abused children, and importance of petechiae.
Systematic Reviews of bruising challenged accepted wisdom regarding ageing of bruises, which had no scientific basis; stimulated higher quality research on patterns of bruises distinguishing abusive and non-abusive bruising patterns, and highlighted the benefits of regular updates of these reviews.
长期以来，关于瘀伤的老化以及某些瘀伤模式是否提示或诊断儿童虐待一直存在教条观念。
我们针对这两个问题进行了首次系统评价，以确定当前临床实践的科学依据。自2004年以来已有七次更新。
在1951年至2004年期间，通过13个数据库进行了全语言文献检索，使用了60多个关键词，并辅以“滚雪球”技术。质量标准包括一个新的虐待确认量表。更新使用了扩展的关键词以及更高的虐待确认标准。
在1495项潜在研究中，2004年只有三项符合瘀伤老化的纳入标准，证实肉眼判断是不准确的。首次报告时这一观点遭到了全面否定，引发了一波新的研究，试图确定一种科学有效的瘀伤老化方法，但目前尚无适用于儿童的方法。关于可能提示或诊断虐待的瘀伤模式，我们纳入了2004年审查的167项研究中的23项，尽管只有2项是比较研究。纳入的研究指出，非故意性瘀伤主要发生在身体前部、骨隆突处，且其出现与儿童的独立活动水平直接相关。受虐儿童的瘀伤模式在位置上有所不同（最常见的部位是面部、颈部、耳部、头部、躯干、臀部、手臂），且往往更大。更新纳入了另外14项研究，包括残疾儿童的瘀伤、确定重度受伤的受虐和非受虐儿童的区别模式以及瘀点的重要性。
瘀伤的系统评价对关于瘀伤老化的公认观点提出了挑战，该观点并无科学依据；激发了关于区分虐待性和非虐待性瘀伤模式的更高质量研究，并强调了定期更新这些评价的益处。
