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Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review. Supplementary material.

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dc.contributor.author Maguire, Sabine Ann ; Pickerd, N. ; Farewell, Daniel ; Mann, M. ; Tempest, V. ; Kemp, Alison M.
dc.date.accessioned 2021-04-20T17:52:09Z
dc.date.available 2021-04-20T17:52:09Z
dc.date.issued 2009
dc.identifier.citation Maguire, Sabine Ann ; Pickerd, N. ; Farewell, Daniel ; Mann, M. ; Tempest, V. ; Kemp, Alison M. (2009). Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review. Archives of Disease in Childhood, 94(11), 860-867. Supplementary Material. en_US
dc.identifier.uri https://adc.bmj.com/content/archdischild/94/11/860.full.pdf?with-ds=yes
dc.identifier.uri http://hdl.handle.net/11212/5056
dc.description.abstract Aim: A systematic review of the scientific literature to define clinical indicators distinguishing inflicted (iBI) from non-inflicted brain injury (niBI). Methods: An all language literature search of 20 electronic databases, websites, references and bibliographies from 1970-2008 was carried out. Relevant studies were independently reviewed by two trained reviewers, with a third review where required. Inclusion criteria included primary comparative studies of iBI and niBI in children aged <18 years, with high surety of diagnosis describing key clinical features. Multilevel logistic regression analysis was conducted, determining the positive predictive value (PPV) and odds ratios (OR) with p values for retinal haemorrhage, rib/long bone/skull fractures, apnoea, seizures and bruising to head/neck. Results: 8151 studies were identified, 320 were reviewed and 14 included, representing 1655 children, 779 with iBI. Gender was not a discriminatory feature. In a child with intracranial injury, apnoea (PPV 93%, OR 17.06, p<0.001) and retinal haemorrhage (PPV 71%, OR 3.504, p = 0.03) were the features most predictive of iBI. Rib fractures (PPV 73%, OR 3.03, p = 0.13) had a similar PPV to retinal haemorrhages, but there were less data for analysis. Seizures and long bone fractures were not discriminatory, and skull fracture and head/neck bruising were more associated with niBI, although not significantly so. Conclusions: This systematic review shows that apnoea and retinal haemorrhage have a high odds ratio for association with iBI. This review identifies key features that should be recorded in the assessment of children where iBI is suspected and may help clinicians to define the likelihood of iBI. (Author Abstract) en_US
dc.language.iso en en_US
dc.publisher Archives of disease in childhood en_US
dc.subject child abuse en_US
dc.subject physical abuse en_US
dc.subject traumatic head injury en_US
dc.subject diagnosis en_US
dc.subject signs and symptoms en_US
dc.subject medical en_US
dc.subject research en_US
dc.subject International Resources en_US
dc.subject United Kingdom en_US
dc.subject Supplementary Material en_US
dc.title Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review. Supplementary material. en_US
dc.type Article en_US


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