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Development of guidelines for skeletal survey in young children with fractures

机译：制定骨折儿童骨骼检查指南

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OBJECTIVE: To develop guidelines for performing initial skeletal survey (SS) in children <24 months old with fractures, based on available evidence and collective judgment of experts from diverse pediatric specialties. METHODS: Following the Rand/UCLA Method, a multispecialty panel of 13 experts applied evidence from a literature review combined with their own expertise in rating the appropriateness of performing an SS for 525 clinical scenarios involving fractures in children <24 months old. After discussion on the initial ratings, panelists rerated SS appropriateness for 240 revised scenarios and deemed that SSs were appropriate in 191 scenarios. The panelists then assessed in which of those 191 scenarios SSs were not only appropriate, but also necessary. RESULTS: Panelists agreed that SS is "appropriate" for 191 (80%) of 240 scenarios rated and "necessary" for 175 (92%) of the appropriate scenarios. Skeletal survey is necessary if a fracture is attributed to abuse, domestic violence, or being hit by a toy. With few exceptions, SS is necessary in children without a history of trauma. In children <12 months old, SS is necessary regardless of the fracture type or reported history, with rare exceptions. In children 12 to 23 months old, the necessity of obtaining SS is dependent on fracture type. CONCLUSIONS: A multispecialty panel reached agreement on multiple clinical scenarios for which initial SS is indicated in young children with fractures, allowing for synthesis of clinical guidelines with the potential to decrease disparities in care and increase detection of abuse.
机译：目的：根据可获得的证据和来自各个儿科专业的专家的集体判断，制定对24岁以下骨折儿童进行初始骨骼检查（SS）的指南。方法：按照兰德/ UCLA方法，由13名专家组成的多学科小组运用了文献综述的证据，结合他们自己的专业知识，对525个24岁以下儿童骨折的临床案例进行SS的适宜性进行了评估。在讨论了初始等级之后，小组成员重新评估了SS对240个修订方案的适用性，并认为SS适用于191个方案。然后，小组成员评估了在这191个方案中，SS不仅合适而且必要。结果：小组成员一致认为，对于240个被评估场景中的191个（80％），SS是“合适的”;对于适当场景中的175个（92％），SS是“必需的”。如果骨折是由于虐待，家庭暴力或被玩具击打造成的，则必须进行骨骼检查。除少数例外，没有创伤史的儿童必须使用SS。在12个月以下的儿童中，无论骨折类型或所报告的病史如何，均需进行SS治疗，但极少数例外。在12至23个月大的儿童中，获得SS的必要性取决于骨折类型。结论：一个多专业小组就多种临床情况达成了共识，在这些临床情况中，骨折的幼儿可使用初始SS，从而可以合成临床指南，从而有可能减少护理方面的差异并增加滥用的检出率。

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