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Development of Hospital-Based Guidelines for Skeletal Survey in Young Children with Bruises

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dc.contributor.author Wood, J. N., Fakeye, O., Mondestin, V., Rubin, D. M., Localio, R., & Feudtner, C.
dc.date.accessioned 2017-01-24T19:27:40Z
dc.date.available 2017-01-24T19:27:40Z
dc.date.issued 2015
dc.identifier.citation Wood, J. N., Fakeye, O., Mondestin, V., Rubin, D. M., Localio, R., & Feudtner, C. (2015). Development of hospital-based guidelines for skeletal survey in young children with bruises. Pediatrics, 135(2), e312-e320. en_US
dc.identifier.uri https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306798/pdf/peds.2014-2169.pdf
dc.identifier.uri http://hdl.handle.net/11212/3179
dc.description.abstract Objective: To develop guidelines for performing an initial skeletal survey (SS) for children <24 months of age presenting with bruising in the hospital setting, combining available evidence with expert opinion. Methods: Applying the Rand/UCLA Appropriateness Method, a multispecialty panel of 10 experts relied on evidence from the literature and their own clinical expertise in rating the appropriateness of performing SS for 198 clinical scenarios characterizing children <24 months old with bruising. After a moderated discussion of initial ratings, the scenarios were revised. Panelists re-rated SS appropriateness for 219 revised scenarios. For the 136 clinical scenarios in which SS was deemed appropriate, the panel finally assessed the necessity of SS. Results: Panelists agreed that SS is “appropriate” for 62% (136/219) of scenarios, and “inappropriate” for children ≥12 months old with nonpatterned bruising on bony prominences. Panelists agreed that SS is “necessary” for 95% (129/136) of the appropriate scenarios. SS was deemed necessary for infants <6 months old regardless of bruise location, with rare exceptions, but the necessity of SS in older children depends on bruise location. According to the panelists, bruising on the cheek, eye area, ear, neck, upper arm, upper leg, hand, foot, torso, buttock, or genital area necessitates SS in children <12 months. Conclusions: The appropriateness and necessity of SS in children presenting for care to the hospital setting with bruising, as determined by a diverse panel of experts, depends on age of the child and location of bruising. (Author Abstract) en_US
dc.language.iso en en_US
dc.publisher Pediatrics en_US
dc.subject child abuse en_US
dc.subject physical examination en_US
dc.subject diagnosis en_US
dc.subject criteria en_US
dc.subject indications en_US
dc.title Development of Hospital-Based Guidelines for Skeletal Survey in Young Children with Bruises en_US
dc.type Article en_US


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