Correlación clínica y radiológica en casos de maltrato infantil
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Objetivo: Describir las características clínicas y radiológicas del abuso físico infantil en una institución Pediátrica de Colombia, y establecer el rendimiento diagnóstico del instrumento de tamización de abuso físico infantil SPUTOVAMO-R y la serie ósea. Metodología: Serie de casos retrospectiva de niños con sospecha de abuso físico infantil que ingresaron por el servicio de urgencias desde enero de 2015 a diciembre de 2016. Se realizó un estudio de rendimiento de pruebas diagnósticas de SPUTOVAMO-R y serie ósea teniendo como estándar de referencia el diagnóstico realizado por el panel de expertos en maltrato infantil. Resultados: De los 43 niños de la muestra, el panel de expertos del hospital determino abuso físico en 30 (16 niños y 14 niñas), siendo más frecuente en menores de 5 años (67%), la lesión centinela más frecuente fue las lesiones múltiples (35%), el abuso físico fue referido por 17 niños (58%), y el riesgo psicosocial más detectado fue el ser hijo de madre soltera (13 casos). SPUTOVAMO-R tuvo sensibilidad de 100%, especificidad de 62%, VPP:86%, VPN:100% y LR-:0,01. La serie ósea tuvo sensibilidad de 67%, especificidad de 100%, VPP:100%, VPN:33% y LR+:67. Conclusiones: Las características del abuso físico infantil fueron similares a lo reportado en la literatura, SPUTOVAMO-R tiene muy buena sensibilidad y buena especificidad, con excelente VPN y LR-, la serie ósea tiene muy buena especificidad y buena sensibilidad, con excelente VPP y LR+, por lo que sugerimos que estas pruebas en conjunto ayudan a establecer el diagnóstico de abuso físico infantil con alta probabilidad.
Abstract. Objective: To describe the clinical and radiological characteristics of childhood physical abuse in a pediatric institution in Colombia, and to establish the diagnostic performance of the SPUTOVAMO-R screening instrument for child abuse, and the skeletal survey. Methodology: Case reports of patients with suspected of child physical abuse of children who were admitted by the emergency department from January 2015 to December 2016. A diagnostic performance study tests of SPUTOVAMO-R and skeletal survey, using the panel of experts on child abuse as standard of reference. Results: Of the 43 patients, the panel of experts determined child physical abuse in 30 (16 boys and 14 girls), being more frequent in children under 5 years (67%), the most frequent sentinel injury was multiple lesions (35%), physical abuse was reported by 17 children (58%), and the most detected psychosocial risk was being the child of a single mother (13 cases). SPUTOVAMO-R had sensitivity of 100%, specificity of 62%, PPV: 86%, NPV: 100% and LR-: 0.01. The skeletal survey had sensitivity of 67%, specificity of 100%, PPV: 100%, NPV: 33% and LR +: 67. Conclusions: The characteristics of childhood physical abuse were similar to those reported in the literature, SPUTOVAMO-R has very good sensitivity and good specificity, with excellent NPV and LR-, the skeletal survey has very good specificity and good sensitivity, with excellent PPV and LR +, so we suggest that these tests together help to establish the diagnosis of child physical abuse with high probability.
Abstract. Objective: To describe the clinical and radiological characteristics of childhood physical abuse in a pediatric institution in Colombia, and to establish the diagnostic performance of the SPUTOVAMO-R screening instrument for child abuse, and the skeletal survey. Methodology: Case reports of patients with suspected of child physical abuse of children who were admitted by the emergency department from January 2015 to December 2016. A diagnostic performance study tests of SPUTOVAMO-R and skeletal survey, using the panel of experts on child abuse as standard of reference. Results: Of the 43 patients, the panel of experts determined child physical abuse in 30 (16 boys and 14 girls), being more frequent in children under 5 years (67%), the most frequent sentinel injury was multiple lesions (35%), physical abuse was reported by 17 children (58%), and the most detected psychosocial risk was being the child of a single mother (13 cases). SPUTOVAMO-R had sensitivity of 100%, specificity of 62%, PPV: 86%, NPV: 100% and LR-: 0.01. The skeletal survey had sensitivity of 67%, specificity of 100%, PPV: 100%, NPV: 33% and LR +: 67. Conclusions: The characteristics of childhood physical abuse were similar to those reported in the literature, SPUTOVAMO-R has very good sensitivity and good specificity, with excellent NPV and LR-, the skeletal survey has very good specificity and good sensitivity, with excellent PPV and LR +, so we suggest that these tests together help to establish the diagnosis of child physical abuse with high probability.