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Ranking of evidence by study type

Ranking of evidence by study type
T1 Randomised controlled trial (RCT)
T2 Controlled trial (CT)
T3 Controlled before-and-after intervention study (CBA)
O1 Cohort study/longitudinal study
O2 Case-control study
O3 Cross-sectional
O4 Study using qualitative methods only
O5 Case series
O6 Case study
X Formal consensus or other professional (expert) opinion (automatic exclusion)


Additional criteria for specific review questions


1. Which fractures are indicative of abuse? – as above


2. What is the evidence for radiological dating of fractures in children? – studies were graded for quality based upon study design, accurate documentation of time of injury and by standardised criteria for radiological dating


3. What radiological investigations should be performed to identify fractures in suspected child abuse? – we also used the following ranking of skeletal survey (SS)



Criteria used to define SS


SS to British Society of Paediatric Radiology/American College of Radiology standards, including oblique views of ribs


SS of all bones: axial/limbs/hands/feet/skull/pelvis/spine.  Views taken specified


SS of skull/long bones/chest/pelvis. No mention of hands or feet


X-ray of skeleton including multiple bone radiology.  No definition of what this included




4. Does cardiopulmonary resuscitation cause rib fractures in children?  – the authors were careful to give the cause of cardiorespiratory collapse and ranks 4/5 were excluded prior to abuse


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