![Page 1: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/1.jpg)
Can Systematic Reviews of Child Protection contribute to
knowledge transfer?
Dr Sabine MaguireSenior Lecturer Child Health
Cardiff University
![Page 2: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/2.jpg)
Do we need SR in Child Protection?
• ‘Baby P doctor under investigation Lawyers claim paediatrician failed to spot broken back and ribs during examination of boy two days before his death’ guardian.co.uk, November 2008
• ‘Sir Roy Meadow struck off by GMC’ www.bbc.co.uk 2005
• ‘Sally Clark doctor wins GMC case’ www.bbc.co.uk 2006
![Page 3: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/3.jpg)
Legal aspects of Child Protection
• Family Courts ‘Balance of probability’ • Criminal courts ‘Beyond reasonable doubt’
• Kennedy report ‘A doctor can be convinced, based on his or her experience, that a defendant is guilty - but unless there is compelling evidence supported scientifically, he or she should not express that view in criminal proceedings’
![Page 4: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/4.jpg)
Challenges of SR in physical abuse
Varying definition of abuse (time/ country/ culture)
Quality and paucity of evidence Lack of case control data Mixed fatal/non-fatal cases Reverse causality
![Page 5: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/5.jpg)
Can you age bruises accurately with the naked eye?
• Ageing of bruises directly influences investigation of child abuse
• Numerous publications ‘timetable’ of colour change in bruises to enable clear dating of injury
Clinicians confident in ageing bruises – welcomed by police / courts
![Page 6: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/6.jpg)
Inclusion and Exclusion Criteria
Included
• All languages • 1950- 2010• Ageing of bruises of
any origin in children between 0-17 years
• Observational studies ( including case series)
Excluded
• Review articles• Expert opinion• No details on
confirmation of age of bruise
• Methodologically flawed
![Page 7: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/7.jpg)
Ageing of Bruises SR: Methodology
• Panel of 15 reviewers ( paediatric, child protection expertise)
• Trained in Critical Appraisal, customised CAF based on NHS CRD standards
2 independent reviews all studies, 3rd review to resolve differences
Narrative summary
![Page 8: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/8.jpg)
Included 3
ASSIA 1987-2010Caredata 1980-2010Child Data 1958-2010CINAHL 1982-2010Embase 1980-2010ISI Proceedings 1990-2007Medline 1950-2010Ovid MEDLINE In-Process & Other Non-Indexed Citations May 2010Science Citation Index 1981-2010SIGLE 1980-2010Social Science CitationIndex 1981-2010TRIP database1997-2010
Hand search of text books
Hand search of all articles identified from other sources
Scanning total titles & abstract for duplicates and relevancy
8102
Total articles reviewed 187
Translated14
3rd Review80
![Page 9: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/9.jpg)
Published evidence in relation to ageing of bruises
• Stephenson T, Bialas Y. ADC 1996 - photos of 23 children, 36 bruises - observer estimate of age correct 24/44, Blue, brown, grey and purple -1-14 days, Yellow - only after 1 day, 10/42 > 1 day
• Carpenter RF. ADC 1999 - 32 bruises in 22 children. Yellow only seen in bruises over 48 hours
• Bariciak ED, Plint AC, et al Pediatrics 2003 -.Red/blue, purple commoner <48hrs, also seen in 30% >7days. Yellow/brown/green most often >7days, but seen in <48 hrs. Accuracy < 50%
![Page 10: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/10.jpg)
Can You Age Bruises Accurately in Children? (with the naked eye)
No!
![Page 11: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/11.jpg)
Ageing – Important Pitfalls
• Different colours present in the same bruise at one time,
• Different areas, different colours • Deep injury – delayed appearance• Individual perception of colour is different
(Munang et al, 2003)• Ability to perceive yellow varies with age
(Hughes et al, 2004)
![Page 12: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/12.jpg)
Ageing of bruises: knowledge transfer
• SR published in ADC in 2005• Review findings initially rejected by
practitioners• Incorporated UK national guidance• Citations (google scholar/ Harzing’s publish or
perish 2012) 71• Stimulated 11 publications aiming to identify
a more scientific method of ageing of bruises
![Page 13: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/13.jpg)
What radiological investigations should be performed to identify
fractures in suspected child abuse?
• 34 studies included in original SR 2004• Key conclusion – single investigation ( skeletal
survey or radionuclide bone scan) will miss occult fractures
• Results published 2006 – RCR/RCPCH National standards for Radiological Investigation Suspected Abuse – March 2008
![Page 14: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/14.jpg)
What radiological investigations should be performed to identify
fractures in suspected child abuse?
• Original SR – 2004 (34 included studies)• Updates 2004-2010 – 13 further studies• Citations:39 studies ( to 2012) • Current accepted practice – single
investigation is inadequate• Current research focusing on what is the
optimal strategy for further Investigations•
![Page 15: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/15.jpg)
CAN SYSTEMATIC REVIEWS OF CHILD PROTECTION CONTRIBUTE TO KNOWLEDGE TRANSFER?
![Page 16: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/16.jpg)
Systematic Reviews of Child Abuse
Challenging to achieve internationally accepted ‘Quality Standards’ for SR
Results may not endorse well established practiceDrives a higher quality research agenda
Establishes state of current evidence for Medical practitioners, Investigating agencies and Legal practitioners
![Page 17: Can Systematic Reviews of Child Protection contribute to knowledge transfer? Dr Sabine Maguire Senior Lecturer Child Health Cardiff University](https://reader035.vdocuments.us/reader035/viewer/2022062619/5518b81955034638098b458a/html5/thumbnails/17.jpg)
Core InfoCardiff Child PrOtection Systematic REviews
Please visit our newly-launched site:
www.core-info.cardiff.ac.uk