The objective was to answer the following four questions:
1. How do you tell by observation alone if a 2-5cm oval / circular injury on a child is a human bite?
(a.k.a. ‘Is this an abusive bite?’)
2a. Does torn labial frenum (frenulum) occur accidentally in children?
2b. Does torn labial frenum (frenulum) occur in abuse in children?
3. What intra-oral injuries occur in child abuse?
We performed an all-language literature search of original articles, their references and conference abstracts published since 1950. The initial search strategy was developed across OVID Medline databases using keywords and Medical Subject Headings (MeSH headings) and was modified appropriately to search the remaining bibliographic databases. The search sensitivity was augmented by the use of a range of supplementary ‘snowballing’ techniques including consultation with subject experts and relevant organisations, and hand searching selected websites, non-indexed journals and the references of all full-text articles.
Standardised data extraction and critical appraisal forms were based on criteria defined by the National Health Service’s Centre for Reviews and Dissemination1. We also used a selection of systematic review advisory articles to develop our critical appraisal forms 2-6. Articles were independently reviewed by two reviewers. A third review was undertaken to resolve disagreement between the initial reviewers when determining either the evidence type of the article or whether the study met the inclusion criteria. Decisions related to inclusion and exclusion criteria were guided by Cardiff Child Protection Systematic Reviews, who laid out the basic parameters for selecting the studies.
Our panel of reviewers included paediatricians, paediatric dentists, designated and named doctors and specialist nurses in child protection. All reviewers underwent standardised critical appraisal training, based on the CRD critical appraisal standards 3, and this was supported by a dedicated electronic critical appraisal module.
- Centre for Reviews and Dissemination. Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care, 2009 Centre for Reviews and Dissemination, University of York. [PDF from York University]
- Weaver N, Williams JL, Weightman AL, Kitcher HN, Temple JM, Jones P, Palmer S. Taking STOX: developing a cross disciplinary methodology for systematic reviews of research on the built environment and the health of the public. Journal of Epidemiology and Community Health. 2002;56(1):48-55. [Pubmed]
Critical Appraisal Skills Programme (CASP) [Website]
- Polgar A, Thomas SA. Chapter 22. Critical evaluation of published research in Introduction to research in the health sciences. 3rd edition. Melbourne: Churchill Livingstone, 1995.
- Weightman AL, Mann MK, Sander L, Turley RL. Health Evidence Bulletins Wales: A systematic approach to identifying the evidence. Project Methodology 5. Cardiff: Information Services UWCM, January 2004. [PDF from Health Evidence Bulletins Wales]
- Rychetnik L, Frommer M. A schema for evaluating evidence on public health interventions (version 4). National Public Health Partnership, Melbourne 2002. [PDF from The National Public Health Partnership]