title: Insufficient evidence for the use of a physical examination to detect maltreatment in children without prior suspicion: a systematic review.
abstract: BACKGROUND
  Although it is often performed in clinical practice, the diagnostic value of a screening physical examination to detect maltreatment in children without prior suspicion has not been reviewed. This article aims to evaluate the diagnostic value of a complete physical examination as a screening instrument to detect maltreatment in children without prior suspicion.
  
  
  METHODS
  We systematically searched the databases of MEDLINE, EMBASE, PsychINFO, CINAHL, and ERIC, using a sensitive search strategy. Studies that i) presented medical findings of a complete physical examination for screening purposes in children 0-18 years, ii) specifically recorded the presence or absence of signs of child maltreatment, and iii) recorded child maltreatment confirmed by a reference standard, were included. Two reviewers independently performed study selection, data extraction, and quality appraisal using the QUADAS-2 tool.
  
  
  RESULTS
  The search yielded 4,499 titles, of which three studies met the eligibility criteria. The prevalence of confirmed signs of maltreatment during screening physical examination varied between 0.8% and 13.5%. The designs of the studies were inadequate to assess the diagnostic accuracy of a screening physical examination for child maltreatment.
  
  
  CONCLUSIONS
  Because of the lack of informative studies, we could not draw conclusions about the diagnostic value of a screening physical examination in children without prior suspicion of child maltreatment.
authors: Department of Paediatrics, Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, Postbus 22660, Amsterdam, 1100 DD, The Netherlands. eva.hoytemavankonijnenburg@amc.nl.
authors: Eva Mm
authors: EM
authors: Hoytema van Konijnenburg
authors: Arianne H
authors: AH
authors: Teeuw
authors: Tessa
authors: T
authors: Sieswerda-Hoogendoorn
authors: Arnold G E
authors: AG
authors: Leenders
authors: Johanna H
authors: JH
authors: van der Lee
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010808:Physical Examination; D012107:Research Design