Division of General Pediatrics and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Leonard Davis Institute of Health Economics and Departments of Pediatrics and
Division of General Pediatrics and PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
Pediatrics. 2015 Feb;135(2):e312-20. doi: 10.1542/peds.2014-2169. Epub 2015 Jan 19.
To develop guidelines for performing an initial skeletal survey (SS) for children <24 months of age presenting with bruising in the hospital setting, combining available evidence with expert opinion.
Applying the Rand/UCLA Appropriateness Method, a multispecialty panel of 10 experts relied on evidence from the literature and their own clinical expertise in rating the appropriateness of performing SS for 198 clinical scenarios characterizing children <24 months old with bruising. After a moderated discussion of initial ratings, the scenarios were revised. Panelists re-rated SS appropriateness for 219 revised scenarios. For the 136 clinical scenarios in which SS was deemed appropriate, the panel finally assessed the necessity of SS.
Panelists agreed that SS is "appropriate" for 62% (136/219) of scenarios, and "inappropriate" for children ≥ 12 months old with nonpatterned bruising on bony prominences. Panelists agreed that SS is "necessary" for 95% (129/136) of the appropriate scenarios. SS was deemed necessary for infants <6 months old regardless of bruise location, with rare exceptions, but the necessity of SS in older children depends on bruise location. According to the panelists, bruising on the cheek, eye area, ear, neck, upper arm, upper leg, hand, foot, torso, buttock, or genital area necessitates SS in children <12 months.
The appropriateness and necessity of SS in children presenting for care to the hospital setting with bruising, as determined by a diverse panel of experts, depends on age of the child and location of bruising.
结合现有证据和专家意见，为 24 个月以下因瘀伤在医院就诊的儿童制定初始骨骼检查（SS）指南。
应用 Rand/UCLA 适宜性方法，由 10 名多学科专家组成的小组根据文献中的证据和他们自己的临床专业知识，对 198 种特征为 24 个月以下瘀伤儿童的临床情况进行 SS 评估的适宜性进行评分。在对初始评分进行了适度的讨论后，对情景进行了修订。小组成员重新对 219 个修订情景进行了 SS 适宜性评分。对于被认为需要进行 SS 的 136 个临床情况，小组最终评估了 SS 的必要性。
小组成员一致认为，SS 对 219 个场景中的 62%（136/219）是“适宜的”，对 12 个月以上、骨突处有非模式化瘀伤的儿童是“不适当的”。小组成员一致认为，在 136 个适宜的情况下，95%（129/136）的 SS 是“必要的”。无论瘀伤位置如何，6 个月以下的婴儿都需要进行 SS，但很少有例外，但年龄较大的儿童是否需要进行 SS 则取决于瘀伤的位置。根据小组成员的意见，如果儿童＜12 个月，脸颊、眼区、耳、颈、上臂、大腿、手、脚、躯干、臀部或生殖器区域的瘀伤需要进行 SS。
由不同专业专家组成的小组确定，24 个月以下因瘀伤在医院就诊的儿童进行 SS 的适宜性和必要性取决于儿童的年龄和瘀伤的位置。
