Ejnell Bjursell Josefine, Wigert Helena, Patriksson Katarina, Nilsson Stefan
Division of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden
Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
BMJ Open. 2025 Aug 4;15(8):e101721. doi: 10.1136/bmjopen-2025-101721.
To evaluate the reliability and validity of screening tools designed to identify child maltreatment by parents or caregivers in paediatric healthcare settings, particularly for use in early childhood or neonatal care.
Systematic literature review.
The Cochrane Library, Embase, Cinahl and Ovid Medline were searched for studies published up to June 2025.
studies evaluating screening tools intended for use by caregivers or healthcare professionals to identify child maltreatment in paediatric healthcare settings. Included tools targeted children under 18 years of age.
Key characteristics of included tools were extracted, including type of maltreatment assessed, number of items, tool format and the age range of the child population. Data on reliability and validity were synthesised narratively due to heterogeneity in methods and outcomes.
Risk of bias and the quality of Patient Reported Outcome Measure development were assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist, which also guided the grading of evidence strength.
In total, 1874 abstracts and 84 full-text articles were reviewed. 14 articles featuring 13 distinct screening tools were identified, most of which were used to detect physical abuse in emergency room settings. Only the Escape tool was evaluated in two studies, both of very good quality; the study evaluating the Pediatric Hurt-Insult-Threaten-Scream-Sex tool also demonstrated very good quality. The remaining studies varied in methodological quality and evidence strength. No tools were identified for children in neonatal care settings, and few were validated for children aged 0-3 years, none for neonatal care.
This review highlights the limited number of validated tools suitable for identifying maltreatment in very young children and across different contexts, particularly neonatal care. Future research should address these critical gaps to better support the early identification of child abuse within diverse clinical settings.
PROSPERO (2023), registration number CRD42023483966.
评估旨在识别儿科医疗环境中父母或照料者对儿童虐待情况的筛查工具的可靠性和有效性，特别是用于幼儿期或新生儿护理。
系统文献综述。
检索Cochrane图书馆、Embase、Cinahl和Ovid Medline截至2025年6月发表的研究。
评估照料者或医疗专业人员用于识别儿科医疗环境中儿童虐待情况的筛查工具的研究。纳入的工具针对18岁以下儿童。
提取纳入工具的关键特征，包括评估的虐待类型、条目数量、工具形式以及儿童群体的年龄范围。由于方法和结果的异质性，对可靠性和有效性数据进行叙述性综合。
使用基于共识的健康测量工具选择标准清单评估偏倚风险和患者报告结局测量工具的开发质量，该清单也指导证据强度分级。
共审查了1874篇摘要和84篇全文文章。确定了14篇文章，其中有13种不同的筛查工具，大多数用于在急诊室环境中检测身体虐待。只有“逃脱”工具在两项质量非常好的研究中得到评估；评估“儿科伤害-侮辱-威胁-尖叫-性”工具的研究也显示质量非常好。其余研究在方法质量和证据强度方面各不相同。未找到适用于新生儿护理环境中儿童的工具，很少有工具针对0至3岁儿童进行验证，没有针对新生儿护理的工具。
本综述强调了适用于识别幼儿及不同环境（特别是新生儿护理）中虐待情况的经过验证的工具数量有限。未来的研究应填补这些关键空白，以更好地支持在不同临床环境中早期识别儿童虐待。
PROSPERO注册号：PROSPERO（2023年），注册号CRD42023483966。
