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Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries: A Systematic Review

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, clari...

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Autores principales: Blangis, Flora, Allali, Slimane, Cohen, Jérémie F., Vabres, Nathalie, Adamsbaum, Catherine, Rey-Salmon, Caroline, Werner, Andreas, Refes, Yacine, Adnot, Pauline, Gras-Le Guen, Christèle, Launay, Elise, Chalumeau, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600386/
https://www.ncbi.nlm.nih.gov/pubmed/34787659
http://dx.doi.org/10.1001/jamanetworkopen.2021.29068
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author Blangis, Flora
Allali, Slimane
Cohen, Jérémie F.
Vabres, Nathalie
Adamsbaum, Catherine
Rey-Salmon, Caroline
Werner, Andreas
Refes, Yacine
Adnot, Pauline
Gras-Le Guen, Christèle
Launay, Elise
Chalumeau, Martin
author_facet Blangis, Flora
Allali, Slimane
Cohen, Jérémie F.
Vabres, Nathalie
Adamsbaum, Catherine
Rey-Salmon, Caroline
Werner, Andreas
Refes, Yacine
Adnot, Pauline
Gras-Le Guen, Christèle
Launay, Elise
Chalumeau, Martin
author_sort Blangis, Flora
collection PubMed
description 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.
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spelling pubmed-86003862021-12-02 Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries: A Systematic Review Blangis, Flora Allali, Slimane Cohen, Jérémie F. Vabres, Nathalie Adamsbaum, Catherine Rey-Salmon, Caroline Werner, Andreas Refes, Yacine Adnot, Pauline Gras-Le Guen, Christèle Launay, Elise Chalumeau, Martin JAMA Netw Open Original Investigation 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. American Medical Association 2021-11-17 /pmc/articles/PMC8600386/ /pubmed/34787659 http://dx.doi.org/10.1001/jamanetworkopen.2021.29068 Text en Copyright 2021 Blangis F et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Blangis, Flora
Allali, Slimane
Cohen, Jérémie F.
Vabres, Nathalie
Adamsbaum, Catherine
Rey-Salmon, Caroline
Werner, Andreas
Refes, Yacine
Adnot, Pauline
Gras-Le Guen, Christèle
Launay, Elise
Chalumeau, Martin
Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries: A Systematic Review
title Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries: A Systematic Review
title_full Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries: A Systematic Review
title_fullStr Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries: A Systematic Review
title_full_unstemmed Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries: A Systematic Review
title_short Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries: A Systematic Review
title_sort variations in guidelines for diagnosis of child physical abuse in high-income countries: a systematic review
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600386/
https://www.ncbi.nlm.nih.gov/pubmed/34787659
http://dx.doi.org/10.1001/jamanetworkopen.2021.29068
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