这孩子是否经历过身体虐待? :理性的临床检查系统审查
Sonal N Shah1, Hiu-Fai Fong2, Suzanne B Haney3
1Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA
|April 21, 2025
概括
儿童的身体虐待是一个严重的担忧, 特殊的伤害如骨撕裂,部伤和视网膜出血表明更高的可能性. 通过临床和放射学发现的早期检测对于干预至关重要.
科学领域:
- 儿童医学
- 法医医学
- 公共卫生
背景情况:
- 身体虐待是导致儿童死亡和受伤的主要原因,
- 准确识别身体虐待对于及时干预和预防严重后果至关重要.
研究的目的:
- 评估临床和放射学发现的诊断准确性,以确定受伤儿童的身体虐待.
- 为临床医生提供基于证据的见解,
主要方法:
- 从1970年到2024年9月,在MEDLINE,PubMed Central和Embase进行了系统的文献搜索.
- 包括的研究描述了对身体虐待进行评估的儿童的临床和放射性特征,由专家小组或标准化标准来确定虐待.
- 对各种发现计算了敏感度,特异性和概率比率 (LR).
主要成果:
- 18项研究符合纳入标准,身体虐待的患病率在5%至79%之间.
- 与滥用的可能性增加相关的具体发现包括口腔损伤 (骨撕裂,LR 6. 6),部伤 (LR 范围15-83),部伤 (LR 范围2. 2-84),有图案的伤 (LR 范围2. 0-66),以及副结膜出血 (LR 范围5. 4-130).
- 在头部受伤的儿童中,视网膜出血 (LR 11. 0),发作 (LR 3. 9),缺氧性缺血性损伤 (LR 3. 4) 和皮下血液瘤 (LR 3. 2) 的可能性增加. 骨调查显示骨折 (单个LR 5. 9,多个LR 3. 8) 也增加了滥用可能性.
结论:
- 临床发现如口腔损伤,特定的伤模式,
- 在头部受伤的婴儿和儿童中神经影像和眼科的发现可以显著帮助确定身体虐待的可能性.
- 这些发现强调了在怀疑虐待儿童的案件中进行彻底体检和适当的诊断工作的重要性.
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