Child maltreatment affects a significant number of children globally. Strategies have been developed to identify children suspected of having been exposed to maltreatment with the aim of reducing further maltreatment and impairment. This systematic review evaluates the accuracy of strategies for identifying children exposed to maltreatment. We conducted a systematic search of seven databases: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Libraries, Sociological Abstracts and the Education Resources Information Center. We included studies published from 1961 to July 2, 2019 estimating the accuracy of instruments for identifying potential maltreatment of children, including neglect, physical abuse, emotional abuse, and sexual abuse. We extracted data about accuracy and narratively synthesised the evidence. For five studies—where the population and setting matched known prevalence estimates in an emergency department setting—we calculated false positives and negatives. We assessed risk of bias using QUADAS-2. We included 32 articles (representing 31 studies) that evaluated various identification strategies, including three screening tools (SPUTOVAMO checklist, Escape instrument, and a 6-item screening questionnaire for child sex trafficking). No studies evaluated the effects of identification strategies on important outcomes for children. All studies were rated as having serious risk of bias (often because of verification bias). The findings suggest that use of the SPUTOVAMO and Escape screening tools at the population level (per 100,000) would result in hundreds of children being missed and thousands of children being over identified. There is low to very low certainty evidence that the use of screening tools may result in high numbers of children being falsely suspected or missed. These harms may outweigh the potential benefits of using such tools in practice (PROSPERO 2016:CRD42016039659).

中文翻译：

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识别遭受虐待的儿童：系统评价更新

儿童虐待在全球范围内影响着大量儿童。为了减少进一步的虐待和伤害，已经制定了策略来识别怀疑受到虐待的儿童。这项系统的评估评估了识别遭受虐待儿童的策略的准确性。我们对七个数据库进行了系统搜索：Medline，Embase，PsycINFO，护理和相关健康文献累积索引，Cochrane图书馆，社会学摘要和教育资源信息中心。我们纳入了1961年至2019年7月2日发布的研究，以评估用于识别潜在的虐待儿童行为的工具的准确性，包括忽视，身体虐待，情感虐待和性虐待。我们提取了有关准确性的数据，并叙述了证据。对于五项研究（人口和环境与急诊部门中已知的患病率估计值相匹配），我们计算了假阳性和阴性。我们使用QUADAS-2评估了偏倚风险。我们收录了32篇文章（代表31项研究），评估了各种识别策略，其中包括三种筛查工具（SPUTOVAMO清单，逃生工具和一项针对儿童性贩运的6项筛查问卷）。没有研究评估识别策略对儿童重要结局的影响。所有研究均被认为具有严重的偏差风险（通常是由于验证偏差）。研究结果表明，在人群中使用了SPUTOVAMO和Escape筛查工具（每100人，000）将导致数百名儿童失踪，数千名儿童被过度识别。有很少到非常低的确定性证据表明，使用筛查工具可能会导致大量儿童被错误地怀疑或错过。这些危害可能超过在实践中使用此类工具的潜在好处（PROSPERO 2016：CRD42016039659）。