Child Abuse/diagnosis; Child, Preschool; Clinical Laboratory Techniques; Developed Countries; Diagnosis, Differential; Female; Humans; Infant; Male; Practice Guidelines as Topic/standards; Wounds and Injuries/diagnosis; Child Abuse; Practice Guidelines as Topic; Wounds and Injuries; Medicine (all)
Abstract :
[en] [en] IMPORTANCE: The highly variable practices observed regarding the early detection and diagnostic workup of suspected child physical abuse contribute to suboptimal care and could be partially related to discrepancies in clinical guidelines.
OBJECTIVE: To systematically evaluate the completeness, clarity, and consistency of guidelines for child physical abuse in high-income countries.
EVIDENCE REVIEW: For this systematic review, national or regional guidelines that were disseminated from 2010 to 2020 related to the early detection and diagnostic workup of child physical abuse in infants aged 2 years or younger by academic societies or health agencies in high-income countries were retrieved. The definitions of sentinel injuries and the recommended diagnostic workup (imaging and laboratory tests) for child physical abuse were compared. Data were analyzed from July 2020 to February 2021.
FINDINGS: Within the 20 included guidelines issued in 15 countries, 168 of 408 expected statements (41%) were missing and 10 statements (4%) were unclear. Among 16 guidelines characterizing sentinel injuries, all of them included skin injuries, such as bruises, hematoma, or burns, but only 8 guidelines (50%) included intraoral injuries and fractures. All 20 guidelines agreed on the indication for radiological skeletal survey, head computed tomography, and head magnetic resonance imaging but differed for those of bone scintigraphy, follow-up skeletal survey, spinal magnetic resonance imaging, cranial ultrasonography, chest computed tomography, and abdominal ultrasonography and computed tomography. Additionally, 16 guidelines agreed on exploring primary hemostasis and coagulation but not on the tests to perform, and 8 guidelines (50%) mentioned the need to investigate bone metabolism.
CONCLUSIONS AND RELEVANCE: These findings suggest that guidelines for the diagnosis of child physical abuse in infants were often clear but lacked completeness and were discrepant on major issues. These results may help identify priorities for well-designed original diagnostic accuracy studies, systematic reviews, or an international consensus process to produce clear and standardized guidelines to optimize practices and infant outcomes.
Disciplines :
Pediatrics
Author, co-author :
Blangis, Flora; Obstetrical, Perinatal and Pediatric Epidemiology Research team, Centre of Research in Epidemiology and Statistics, Université de Paris, INSERM, F-75004, Paris, France ; Inserm CIC 1413, Nantes University Hospital, F-44000, Nantes, France ; Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, F-75015, Paris, France
Allali, Slimane; Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, F-75015, Paris, France
Cohen, Jérémie F; Obstetrical, Perinatal and Pediatric Epidemiology Research team, Centre of Research in Epidemiology and Statistics, Université de Paris, INSERM, F-75004, Paris, France ; Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, F-75015, Paris, France
Vabres, Nathalie; Unité d'Accueil des Enfants en Danger, Nantes University Hospital, F-44000, Nantes, France
Adamsbaum, Catherine; Department of Pediatric Radiology, AP-HP, Bicêtre Hospital, F-94270, Le Kremlin Bicêtre, France
Rey-Salmon, Caroline; Pediatrics and Forensic Unit, AP-HP, Hôtel-Dieu Hospital, F-75004, Paris, France
Werner, Andreas; AFPA, Association Française de Pédiatrie Ambulatoire, F-30400, Villeneuve les Avignons, France
Adnot, Pauline; Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, F-75015, Paris, France
Gras-Le Guen, Christèle; Obstetrical, Perinatal and Pediatric Epidemiology Research team, Centre of Research in Epidemiology and Statistics, Université de Paris, INSERM, F-75004, Paris, France ; Inserm CIC 1413, Nantes University Hospital, F-44000, Nantes, France ; Department of Pediatric Emergency Care, Nantes University Hospital, F-44000, Nantes, France
Launay, Elise; Obstetrical, Perinatal and Pediatric Epidemiology Research team, Centre of Research in Epidemiology and Statistics, Université de Paris, INSERM, F-75004, Paris, France ; Inserm CIC 1413, Nantes University Hospital, F-44000, Nantes, France ; Department of Pediatric Emergency Care, Nantes University Hospital, F-44000, Nantes, France
Chalumeau, Martin; Obstetrical, Perinatal and Pediatric Epidemiology Research team, Centre of Research in Epidemiology and Statistics, Université de Paris, INSERM, F-75004, Paris, France ; Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, F-75015, Paris, France
European Confederation of Primary Care Paediatricians (ECPCP) research group
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