Obstetrical, Perinatal and Pediatric Epidemiology Research team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, F-75004 Paris, France
Inserm CIC 1413, Nantes University Hospital, F-44000 Nantes, France.
Arch Dis Child. 2021 Apr;106(4):361-366. doi: 10.1136/archdischild-2020-319065. Epub 2020 Sep 30.
To systematically assess the extent to which bone scintigraphy (BS) could improve the detection rate of skeletal injury in children suspected of physical abuse with an initial negative radiological skeletal survey (RSS).
We searched MEDLINE and Web of Science for series of ≥20 children suspected of physical abuse who underwent RSS and add-on BS. We assessed the risk of bias and the heterogeneity and performed random-effects meta-analyses.
After screening 1140 unique search results, we reviewed 51 full-text articles, and included 7 studies (783 children, mostly ≤3 years old). All studies were of either high or unclear risk of bias. Substantial heterogeneity was observed in meta-analyses. The summary detection rate of skeletal injury with RSS alone was 52% (95% CI 37 to 68). The summary absolute increase in detection rate with add-on BS was 10 percentage points (95% CI 6 to 15); the summary relative detection rate was 1.19 (95% CI 1.13 to 1.25); the summary number of children with a negative RSS who needed to undergo a BS to detect one additional child with skeletal injury (number needed to test) was 3 (95% CI 2 to 7).
From the available evidence, add-on BS in young children suspected of physical abuse with a negative RSS might allow for a clinically significant improvement of the detection rate of children with skeletal injury, for a limited number of BS procedures required. The quality of the reviewed evidence was low, pointing to the need for high-quality studies in this field.
系统评估骨闪烁扫描（BS）在初始阴性放射学骨骼检查（RSS）后，对疑似身体虐待的儿童骨骼损伤检测率的提高程度。
我们在 MEDLINE 和 Web of Science 上搜索了≥20 名疑似身体虐待并接受 RSS 和附加 BS 的儿童系列研究。我们评估了偏倚风险和异质性，并进行了随机效应荟萃分析。
在筛选了 1140 个独特的搜索结果后，我们回顾了 51 篇全文文章，并纳入了 7 项研究（783 名儿童，大多≤3 岁）。所有研究均存在高或不明确的偏倚风险。荟萃分析中观察到显著的异质性。单独使用 RSS 的骨骼损伤检测率综合为 52%（95% CI 37 至 68）。附加 BS 的绝对检测率综合增加 10 个百分点（95% CI 6 至 15）；综合相对检测率为 1.19（95% CI 1.13 至 1.25）；需要进行 BS 以检测额外一名骨骼损伤儿童的 RSS 阴性儿童数量（需要检测的数量）综合为 3（95% CI 2 至 7）。
根据现有证据，在 RSS 阴性疑似身体虐待的幼儿中，附加 BS 可能会在有限数量的 BS 检查所需的情况下，显著提高骨骼损伤儿童的检测率。审查证据的质量较低，表明该领域需要高质量的研究。
