Rees P, Al-Hussaini A, Maguire S
Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK.
Department of Otolaryngology, Head and Neck Surgery, University Hospital of Wales, Cardiff, UK.
Clin Otolaryngol. 2017 Aug;42(4):783-804. doi: 10.1111/coa.12668. Epub 2016 May 30.
Child maltreatment is persistently under-recognised. Given that a third of maltreated children may return with serious or fatal injuries, it is imperative that otolaryngologists who are in frequent contact with children are able to detect maltreatment at first presentation.
This review aims to identify ENT injuries, signs or symptoms that are indicative of physical abuse or fabricated or induced illness (child maltreatment).
Systematic review.
An all-language search, developed in Medline Ovid and consisting of 76 key words, was conducted of published and grey literature across 10 databases from inception to July 2015, for primary observational studies involving children aged <18 years.
Each relevant article underwent two independent reviews with full critical appraisal, applying strict quality standards.
Of the 2448 studies identified and screened, 371 underwent full review, resulting in 38 included studies that detailed 122 maltreated children. Pharyngeal perforations (n = 20) were the most frequent abusive ENT injury, predominantly affecting neonates and infants, presenting with dysphagia, drooling, haemoptysis and surgical emphysema. At least 52% of children with abusive pharyngeal injuries had additional co-existent injuries. The majority of ear injuries were inflicted to the external ear (n = 11) and included auricular deformity, abrasions, petechiae, lacerations and burns. Fabricated or induced illness cases presented most commonly with recurrent, unexplained otorrhoea or ENT lesions that failed to heal despite appropriate therapy.
All clinicians should be familiar with the signs of child maltreatment. Pharyngeal injuries, or injuries to the external ear, presenting in young children without an explicit history of witnessed injury should prompt a child protection referral for full evaluation. Likewise, children who present with recurrent, or apparently intractable symptoms and signs despite appropriate treatment, should raise the possibility of fabricated or induced illness, and discussion with a child protection specialist is advised. Early recognition of possible child maltreatment and instigation of appropriate safeguarding measures are essential to prevent repetition and escalation of injury. This is of paramount importance to otolaryngologists, who have the potential to identify these children in their practice.
儿童虐待一直未得到充分认识。鉴于三分之一受虐儿童可能会带着重伤或致命伤复诊，经常接触儿童的耳鼻喉科医生必须能够在初次就诊时就发现虐待情况。
本综述旨在确定耳鼻喉科损伤、体征或症状，这些可表明身体虐待或造作性或诱导性疾病（儿童虐待）。
系统综述。
在Medline Ovid中制定了一项全语言检索策略，包含76个关键词，对从创刊至2015年7月期间10个数据库中的已发表文献和灰色文献进行检索，以查找涉及18岁以下儿童的原发性观察性研究。
每篇相关文章都经过两次独立评审，并进行全面的严格评估，采用严格的质量标准。
在识别和筛选出的2448项研究中，371项进行了全面评审，最终纳入38项研究，这些研究详细描述了122名受虐儿童。咽穿孔（n = 20）是最常见的虐待性耳鼻喉科损伤，主要影响新生儿和婴儿，表现为吞咽困难、流口水、咯血和手术性气肿。至少52%的咽部受虐儿童还存在其他合并损伤。大多数耳部损伤发生在外耳（n = 11），包括耳廓畸形、擦伤、瘀点、撕裂伤和烧伤。造作性或诱导性疾病病例最常见的表现是反复出现无法解释的耳漏或耳鼻喉科病变，尽管进行了适当治疗仍未愈合。
所有临床医生都应熟悉儿童虐待的体征。幼儿出现无明确目击受伤史的咽部损伤或外耳损伤，应促使转诊至儿童保护机构进行全面评估。同样，尽管接受了适当治疗仍出现反复或明显难以治愈的症状和体征的儿童，应提高存在造作性或诱导性疾病的可能性，建议与儿童保护专家进行讨论。尽早识别可能的儿童虐待并采取适当的保护措施对于防止伤害的重复和升级至关重要。这对耳鼻喉科医生尤为重要，因为他们有能力在临床工作中识别这些儿童。
