Chest radiography in non-accidental injury
| Citation | Study group | Study type (level of evidence) | Outcome (for non-accidental injury) | Key results | Comments |
|---|---|---|---|---|---|
| Barsness et al, USA (2003) | 62 children with rib fractures (<3 years). Sub-analysis of 3 758 trauma evaluations) presenting to a US Level 1 Trauma Centre | Case series with non-independent reference standard (3B) | PPV | Retrospective study | |
| Paper | 95% | Unclear how figure in paper is derived | |||
| Raw data analysis | 82.3 (70–91)% | Criteria for diagnosis of non-accidental injury not defined | |||
| Carty and Pierce, UK (2002) | 467 (425 <2 years) children referred for second opinion as to cause of injuries | Case series with non-independent reference standard (3B) | Specificity PPV | 100 (96–100)% 100 (96–100)% | Retrospective personal case series |
| Bulloch et al, USA (2000) | 39 children (<12 months of age) identified as having rib fractures on basis of standard American radiology codes | Case series with non-independent reference standard (3B) | Positive predictive value | 82 (66.5–82.5)% | Retrospective study |
| Each film reported by a single radiologist, with causality determined by case review involving 2 paediatricians | |||||
| Small numbers | |||||
| Cadzow and Armstrong, Australia (2000) | 18 infants (<2 years) with documented rib fractures in a tertiary referral paediatric centre | Case series with non-independent reference standard (3B) | Positive predictive value | 83 (58.6–96.4)% | Retrospective study |
| Each child’s case reviewed by multi-disciplinary team to determine whether child was abused or not | |||||
| Small numbers | |||||
| Leventhal et al, USA (1993) | 215 children (<3 years) with fractures. Data collection from Emergency Medicine Department logs and Child Abuse Register | Case series with non-independent reference standard (3B) | Specificity | 100 (94–100)% | Retrospective study |
| Garcia et al, USA (1990) | Case review of 2 080 trauma evaluations at Level 1 trauma centre. 33 children (0–13 years) with a rib fracture | Case series with non-independent reference standard (3B) | Positive predictive value | 21 (9–39)% | Retrospective review |
| No gold standard for NAI defined | |||||
| Not specifically looking at rib fractures in non-accidental injury | |||||
| Set in trauma centre | |||||
| King et al, USA (1988) | 189 (<1 month to 13 years) children referred to an assessment team for investigation of abuse. 163 less than 2 years of age | Case series with non-independent reference standard (3B) | Sensitivity | 18 (12.8–24.2)% | Retrospective study |
| Not explicitly stated whether all children received a chest radiograph | |||||
| Wide age range | |||||
| Schweich and Fleisher, USA (1985) | 21 children (3 months to 15 years 4 months) admitted to paediatric emergency care facility with rib fractures | Case series with non-independent reference standard (3B) | Positive predictive value | 23 (5–41)% | Retrospective study |
| Small numbers | |||||
| Wide age range | |||||
| Merten et al, USA (1983) | Initial recruitment of 904 infants and children (3 weeks to 16 years) with “strong clinical evidence of abuse”. 494 complete radiological examinations included in the analysis | Case series with non-independent reference standard (3B) | Age (years) stratified sensitivity | Retrospective | |
| <1 (n = 190) | 10 (6–15)% | ||||
| 1–2 (n = 101) | 8 (4–15)% | ||||
| 2–5 (n = 128) | 2.3 (0.5–6.7)% | ||||
| >5 (n = 75) | 1.3 (0.0–7.2)% | ||||
| All ages | 6.3 (4.3–8.8)% | ||||
| Thomas, UK (1977) | 25 infants (<1 year) with rib fracture | Case series with non-independent reference standard (3B) | Positive predictive value | 24 (8–40)% | Inpatients and outpatients analysed |
| Data collected 1969–1979 | |||||
| Small numbers |