Otterman Gabriel, Nurmatov Ulugbek B, Akhlaq Ather, Korhonen Laura, Kemp Alison M, Naughton Aideen, Chalumeau Martin, Jud Andreas, Vollmer Sandholm Mary Jo, Mora-Theuer Eva, Moultrie Sarah, Lamela Diogo, Tagiyeva-Milne Nara, Nelson Joanne, Greenbaum Jordan
Barnafrid and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
Lancet Reg Health Eur. 2024 Feb 21;39:100868. doi: 10.1016/j.lanepe.2024.100868. eCollection 2024 Apr.
The clinical management of Child sexual abuse (CSA) demands specialised skills from healthcare professionals due to its sensitivity, legal implications, and serious physical health and mental health effects. Standardised, comprehensive clinical practice guidelines (CPGs) may be pivotal. In this systematic review, we examined existing CSA national CPGs (NCPGs) from European countries to assess their quality and reporting.
We systematically searched six international databases and multiple grey literature sources, reporting by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Eligible guidelines were CSA guidance from national health agencies or societies in 34 COST Action 19106 Network Countries (CANC), published between January 2012 and November 2022. Two independent researchers searched, screened, reviewed, and extracted data. NCPGs were compared for completeness with reference WHO 2017 and 2019 guidelines. We used the Appraisal of Guidelines for Research and Evaluation (AGREE II) to appraise quality and reporting. : CRD42022320747.
Of 2919 records identified by database searches, none met inclusion criteria. Of 4714 records identified by other methods, 24 NCPGs from 17 (50%) of CANC countries were included. In 17 (50%) of eligible countries, no NCPGs were found. Content varied significantly within and between countries. NCPGs lacked many components in state-of-the art clinical practice compared to WHO reference standards, particularly in safety and risk assessment, interactions with caregivers, and mental health interventions. Appraisal by AGREE II revealed shortcomings in NCPG development, regarding scientific rigour, stakeholder involvement, implementation and evaluation.
A notable number of European countries lack an NCPG; existing NCPGs often fall short. The healthcare response to CSA in Europe requires a coordinated approach to develop and implement high-quality CPGs. We advocate for a multidisciplinary team to develop a pan-European CSA guideline to ensure quality care for survivors.
Funding was provided by the International Centre for Missing and Exploited Children.
儿童性虐待（CSA）的临床管理因其敏感性、法律影响以及对身体健康和心理健康的严重影响，需要医疗保健专业人员具备专业技能。标准化、全面的临床实践指南（CPG）可能至关重要。在本系统评价中，我们研究了欧洲国家现有的CSA国家临床实践指南（NCPG），以评估其质量和报告情况。
我们按照系统评价和Meta分析的首选报告项目（PRISMA）标准，系统检索了六个国际数据库和多个灰色文献来源。符合条件的指南是2012年1月至2022年11月期间34个欧洲科学技术合作组织（COST）行动19106网络国家（CANC）的国家卫生机构或协会发布的CSA指南。两名独立研究人员进行检索、筛选、评审和数据提取。将NCPG与世界卫生组织2017年和2019年的参考指南进行完整性比较。我们使用指南研究与评价工具（AGREE II）对质量和报告进行评估。注册号：CRD42022320747。
通过数据库检索识别出2919条记录，无一符合纳入标准。通过其他方法识别出4714条记录，其中包括来自17个（50%）CANC国家的24份NCPG。在17个（50%）符合条件的国家中，未找到NCPG。各国之间以及国家内部的内容差异很大。与世界卫生组织参考标准相比，NCPG在最新临床实践中缺少许多内容，特别是在安全和风险评估、与照顾者的互动以及心理健康干预方面。AGREE II评估显示，NCPG在制定方面存在缺陷，在科学严谨性、利益相关者参与、实施和评估方面均有不足。
相当数量的欧洲国家缺乏NCPG；现有的NCPG往往存在不足。欧洲对CSA的医疗应对需要一种协调一致的方法来制定和实施高质量的CPG。我们主张成立一个多学科团队来制定泛欧洲CSA指南，以确保为幸存者提供优质护理。
由国际失踪和受剥削儿童中心提供资金。
