The German Evidence-Based Child Protection Guideline – Imaging in Suspected Child Abuse

Abstract

Aim Development of a fully evidence-based guideline including all aspects of child abuse. Methods In a case-based procedure, 144 primary PICO questions were generated from 476 presented cases of child abuse. Literature research was performed in 5 databases (Pubmed, CINHAL, Embase, PsycInfo, Eric) and in the Cochrane Library. The literature was evaluated according to SIGN and AGREE II. Results 137 recommendations were developed. Those related to imaging procedures are presented and discussed in this article. Conclusion The first fully evidence-based German guideline concerning all aspects of child abuse has been established. For imaging, several relevant new approaches have been proposed. Key Points: Citation Format

Relevance of Routine Abdominopelvic Ultrasound in Suspected Child Abuse in Children Under 2 years of Age: Review of 15 years of Experience

“…The Korean recommendations suggest the use of IV-CT in cases of vital distress or deterioration of the hepatic or pancreatic assays but the use of US in the event of weak suspicion of abdominal injury (Jeon et al, 2020). There is no clear recommendation in Germany; however, if abdominal injury is suspected, US is recommended as the first-line examination (Born et al, 2020; Erfurt et al, 2009). To our knowledge, there are no established recommendations in South American countries and other Asian countries.…”

Child abuse and neglect: A comparative study between dental and medical students' competencies in Germany

“…7 Since this type of violence often occurs in the closest family circle, 8 experts assume that the number of unreported cases is significantly higher. [8][9][10] The prevalence of data recorded by the police and other institutions is correspondingly low. 11,12 To ensure safe handling of suspected cases of CAN, it is important to involve this topic in under-and postgraduate curricula of Dentistry and Medicine.…”

“…18.352 cases (3.758 physical abuse; 14.594 sexual abuse) were reported to the police 7 . Since this type of violence often occurs in the closest family circle, 8 experts assume that the number of unreported cases is significantly higher 8–10 . The prevalence of data recorded by the police and other institutions is correspondingly low 11,12 …”

Canadian Association of Radiologists Trauma Diagnostic Imaging Referral Guideline

“…T21. Non-accidental trauma 9,27,38,[48][49][50] 1. In children with suspected non-accidental trauma, we recommend skeletal survey XR as the initial imaging modality (↑↑).…”

“…Association for the Surgery of Trauma, [31][32][33] the European Society of Musculoskeletal Radiology, 34 the European Society for Sports Traumatology, Knee Surgery and Arthroscopy, 35 the European Society for Sports Traumatology, Knee Surgery and Arthroscopy with the Ankle and Foot Associates, Knee Surgery and Arthroscopy, 36 the French guideline [the French Society of Anaesthesiology and Critical Care Medicine, the French Society of Emergency Medicine, the French Society of Urology, the French Association of Surgery, the Val-de-Grâce School, and the Federation for Interventional Radiology], 37 the German guideline under the auspices of the German Society for Child Protection in Medicine, 38 the German Society for Orthopedic and Trauma Spine Section, 39 the Italian Society of Pediatric Emergency Medicine, 40 the Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency, 41 the National Institute for Health and Care Excellence, [42][43][44][45][46][47] the Pediatric Cervical Spine Clearance Working Group, 48 the Royal College of Radiologists, 49,50 the Scandinavian guideline, 51 the Spinal Cord Society, 51 the World Federation of Neurosurgical Societies Spine Committee, 53,54 and the World Society of Emergency Surgery. [55][56][57][58] Recommendations are presented in 3 tables: Head, facial, orbital, and spine trauma (Table 2), hip and pelvic, arms, and legs trauma (Table 3), and superficial soft tissue foreign body, chest, abdomen, and non-accidental trauma (Table 4).…”