Details of HTA project
Last updated: 26 August 2008 - Next update due: 2 September 2008
Research type: |
Secondary Research (e.g. systematic review) |
Project title: |
Accuracy of screening procedures for non-accidental injury in children: systematic review and modelling of clinical effectiveness |
Project ref: |
03/37/06 |
Cost: |
£91,579 |
Chief Investigator : |
Professor Ruth Gilbert, Professor of Clinical Epidemiology & Director, Centre for Evidence Based Child Health, University College London |
Start Date: |
January 2005. |
Publication date: |
October 2008. This project is at the editorial review stage. Delays in the review process can cause the forecast publication date to be delayed. |
Plain English Summary |
Non-accidental injury (NAI) of children is an important and emotive topic. Screening for this form of child abuse, in hospital emergency departments (separating possible NAI from probable-unintentional injury - 'accidents'), might be expected to result in more reliable identification of cases, better child protection, avoidance of (inadvertent) false accusations of abuse, and enable effective, beneficial interventions. However screening is a difficult area and is often disappointing. To assess the benefits and possible disadvantages of such screening, we will undertake a systematic review - of the relevant medical literature, both published and unpublished. We will undertake the review in four phases: Firstly we will examine how NAI in children can be suspected in A&E departments, and determine the consequences of failing to detect it. Secondly we will review the accuracy of screening tests, broadly grouped as: clinical (history, examination, necessary investigations) and record-based (including nurse review, but particularly electronic data linkage - between hospitals and agencies. This will include our unpublished data on a large London child population). Thirdly we will assess the acceptability and feasibility of screening tests, concentrating on UK studies. Finally, we will use statistical and modelling techniques, aiming to resolve methodological problems, especially the lack in this area of a clear independent 'gold' standard - which would reliably confirm the accuracy of NAI diagnosis in children attending A&E departments - but also to assess the problem of 'missed' cases. Our report to the HTA will include recommendations and identify areas of uncertainty or difficulty, where further research might be helpful. |
Abstract: |
Screening for intentional injury in children presenting to hospital emergency departments could lead to accurate diagnosis of such child abuse and to effective interventions. However this is a very complex area with many areas of uncertainty. Incorrect diagnosis (false positive or false negative) has major implications for children, families and services; false positive screening also has many disadvantages. We will undertake a series of systematic reviews based on the commissioning brief, together with modelling to assess clinical effectiveness. Among the many candidate screening tools, linked information from different health sources, could be especially helpful. We will have unpublished data on this, drawing on a population of 150,000 children in North and East London. |
MeSH* index primary terms: |
CHILD-ABUSE Q-diagnosis; WOUNDS-AND-INJURIES Q-etiology; MASS-SCREENING; CHILD-HEALTH-SERVICES |
MeSH* index secondary terms: |
HUMAN; CHILD |
NRR* number, if applicable: |
N0484149101 (*National Research Register) |
Project Protocol: |
Project protocol not available |
URL of this page: |
http://www.hta.ac.uk/1413 |
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