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Add-on bone scintigraphy after negative radiological skeletal survey for the diagnosis of skeletal injury in children suspected of physical abuse: a systematic review and meta-analysis
  1. Flora Blangis1,2,3,
  2. Melissa Taylor3,
  3. Catherine Adamsbaum4,
  4. Anne Devillers5,
  5. Christèle Gras-Le Guen1,2,6,
  6. Elise Launay1,2,6,
  7. Patrick M Bossuyt7,
  8. Jérémie F Cohen1,3,
  9. Martin Chalumeau1,3
  1. 1Obstetrical, Perinatal and Pediatric Epidemiology Research team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, F-75004 Paris, France
  2. 2Inserm CIC 1413, Nantes University Hospital, F-44000 Nantes, France
  3. 3Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université de Paris, F-75015 Paris, France
  4. 4Department of Pediatric Radiology, AP-HP, Bicêtre hospital, F-94270 Le Kremlin Bicêtre, France
  5. 5Department of Nuclear Medicine, Centre Eugène Marquis, F-35000 Rennes, France
  6. 6Department of Pediatric Emergency Care, Nantes University Hospital, F-44000 Nantes, France
  7. 7Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Flora Blangis, Obstetrical, Perinatal and Pediatric Epidemiology Research team, Epidemiology and Statistics Research Center, Université de Paris, INSERM, F-75004 Paris, France; flora.blangis{at}inserm.fr

Abstract

Objective(s) To systematically assess the extent to which bone scintigraphy (BS) could improve the detection rate of skeletal injury in children suspected of physical abuse with an initial negative radiological skeletal survey (RSS).

Study design We searched MEDLINE and Web of Science for series of ≥20 children suspected of physical abuse who underwent RSS and add-on BS. We assessed the risk of bias and the heterogeneity and performed random-effects meta-analyses.

Results After screening 1140 unique search results, we reviewed 51 full-text articles, and included 7 studies (783 children, mostly ≤3 years old). All studies were of either high or unclear risk of bias. Substantial heterogeneity was observed in meta-analyses. The summary detection rate of skeletal injury with RSS alone was 52% (95% CI 37 to 68). The summary absolute increase in detection rate with add-on BS was 10 percentage points (95% CI 6 to 15); the summary relative detection rate was 1.19 (95% CI 1.13 to 1.25); the summary number of children with a negative RSS who needed to undergo a BS to detect one additional child with skeletal injury (number needed to test) was 3 (95% CI 2 to 7).

Conclusions From the available evidence, add-on BS in young children suspected of physical abuse with a negative RSS might allow for a clinically significant improvement of the detection rate of children with skeletal injury, for a limited number of BS procedures required. The quality of the reviewed evidence was low, pointing to the need for high-quality studies in this field.

  • child abuse
  • imaging
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Footnotes

  • Contributors CA and AD conceptualised the study and revised the manuscript. MT, EL and CGL conceptualised and designed the study, coordinated and supervised data collection and revised the manuscript. PMB designed the study and revised the manuscript. JFC and MC conceptualised and designed the study, collected data, carried out the analyses and drafted the initial manuscript. FB designed the study, collected data, carried out the analyses and drafted the initial manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

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