Abstract
Background
The diagnosis of suspected physical abuse (SPA) remains a continuous challenge to paediatric healthcare. Several studies have reported that computed tomography (CT) may improve the evaluation of SPA.
Objective
This study aims to systematically review the diagnostic performance of CT compared to radiography in investigating SPA.
Materials and methods
Multiple databases were searched, using PRISMA methods, from 2008 to July 2023 for relevant studies in English. Two reviewers independently screened and selected relevant studies using Covidence software. The QUADAS-2 tool was used for the quality assessment of the included papers. Sensitivity, specificity and the effective radiation dose of CT and radiography from the included studies were extracted. Pooled sensitivity and specificity were calculated with their respective 95% confidence intervals (CI).
Results
Of the 4057 identified papers, 10 met the inclusion criteria; all 10 included skull and/or chest. The overall sensitivity and specificity of CT were 96.5% (95%CI: 94.9–97.7%) and 99.5% (95%CI: 99.1–99.8%), respectively. Compared to the sensitivity and specificity of radiography, 59.8% (95%CI: 56.2–63.3%) and 99.7% (95%CI: 99.3–99.8%), respectively.
Conclusion
The sensitivity of CT is significantly higher than radiography for non-accidental rib and skull fractures. With modern CT technologies, there is potential for substantial radiation dose optimisation. CT imaging should be further investigated as a viable option when managing SPA cases.