Is early detection of abused children possible?: a systematic review of the diagnostic accuracy of the identification of abused children

BMC Pediatrics

Louis-Rachid Salmi¹  Pascal Pillet³  Valériane Leroy²  Marion Bailhache² 

[1] CHU de Bordeaux, Pole de sante publique, Service d’information medicale, F-33000 Bordeaux, France;Centre INSERM U897-Epidemiologie-Biostatistique, INSERM, ISPED, F-33000 Bordeaux, France;CHU de Bordeaux, Pole de pediatrie, F-33000 Bordeaux, France

关键词: Diagnostic accuracy;    Systematic review;    Child neglect;    Child abuse;   

Others  :  1144105
DOI  :  10.1186/1471-2431-13-202

 received in 2013-04-26, accepted in 2013-11-20,  发布年份 2013

【 摘 要 】

Background

Early detection of abused children could help decrease mortality and morbidity related to this major public health problem. Several authors have proposed tools to screen for child maltreatment. The aim of this systematic review was to examine the evidence on accuracy of tools proposed to identify abused children before their death and assess if any were adapted to screening.

Methods

We searched in PUBMED, PsycINFO, SCOPUS, FRANCIS and PASCAL for studies estimating diagnostic accuracy of tools identifying neglect, or physical, psychological or sexual abuse of children, published in English or French from 1961 to April 2012. We extracted selected information about study design, patient populations, assessment methods, and the accuracy parameters. Study quality was assessed using QUADAS criteria.

Results

A total of 2 280 articles were identified. Thirteen studies were selected, of which seven dealt with physical abuse, four with sexual abuse, one with emotional abuse, and one with any abuse and physical neglect. Study quality was low, even when not considering the lack of gold standard for detection of abused children. In 11 studies, instruments identified abused children only when they had clinical symptoms. Sensitivity of tests varied between 0.26 (95% confidence interval [0.17-0.36]) and 0.97 [0.84-1], and specificity between 0.51 [0.39-0.63] and 1 [0.95-1]. The sensitivity was greater than 90% only for three tests: the absence of scalp swelling to identify children victims of inflicted head injury; a decision tool to identify physically-abused children among those hospitalized in a Pediatric Intensive Care Unit; and a parental interview integrating twelve child symptoms to identify sexually-abused children. When the sensitivity was high, the specificity was always smaller than 90%.

Conclusions

In 2012, there is low-quality evidence on the accuracy of instruments for identifying abused children. Identified tools were not adapted to screening because of low sensitivity and late identification of abused children when they have already serious consequences of maltreatment. Development of valid screening instruments is a pre-requisite before considering screening programs.

【 授权许可】

   
2013 Bailhache et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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