本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.0276

摘要内容如下：

重要性

儿童虐待与严重的负面生理、心理和行为后果有关。

目的

回顾预防儿童虐待的初级保健可行或可参考干预措施的证据，以告知美国预防服务工作组。

数据源

PubMed、Cochrane图书馆和试验注册至2023年2月2日；截至2023年12月6日的参考资料、专家和监测。

研究选择

对18岁以下的青少年（或其照顾者）进行英语随机临床试验，没有已知的暴露或当前或过去虐待的迹象或症状。

数据提取与合成

两名评价者评估了标题/摘要、全文文章和研究质量，并提取了数据；当至少有3项类似研究可用时，进行荟萃分析。

主要成果和措施

直接衡量虐待或忽视儿童的报告（向儿童保护机构报告或将儿童从家中带走）；虐待或忽视的替代措施（受伤、急诊、住院）；行为、发展、情感、精神或身体健康和幸福；死亡率；哈姆斯。

结果

纳入25个试验（n=14355名参与者）；23人包括家访。来自11项研究（5311名参与者）的证据表明，在干预完成后1年内向儿童保护服务机构报告的可能性没有差异（合并优势比，1.03[95%CI，0.84-1.27]）。五项研究（3336名参与者）发现，在1至3年的随访中，将儿童从家中带走没有差异（合并风险比，1.06[95%CI，0.37-2.99]）。有证据表明，短期（<2年）急诊就诊和住院治疗没有益处。由于每个结果的试验数量有限且结果不精确，所有其他结果的证据都不确定。在2个报告危害的试验中，均未报告统计学上的显著差异。背景证据表明：（1）在筛查、识别和向儿童保护服务机构报告虐待儿童行为时，做法千差万别，包括种族或民族差异；（2）筛查仪器的准确性差异很大；（3）有证据表明，儿童虐待干预措施可能与健康的某些社会决定因素的改善有关。

结论和相关性

在初级保健机构中可行或可参考的预防儿童虐待的干预措施的证据基础表明，儿童虐待的直接或代理措施没有益处或证据不足。关于可能的危害的信息很少。背景证据表明，在儿童虐待的筛查、识别和报告中可能存在偏见或不准确，但也强调了在干预预防儿童虐待时解决社会决定因素的重要性。

英文原文如下：

Abstracts

Importance  Child maltreatment is associated with serious negative physical, psychological, and behavioral consequences.

Objective  To review the evidence on primary care-feasible or referable interventions to prevent child maltreatment to inform the US Preventive Services Task Force.

Data Sources  PubMed, Cochrane Library, and trial registries through February 2, 2023; references, experts, and surveillance through December 6, 2023.

Study Selection  English-language, randomized clinical trials of youth through age 18 years (or their caregivers) with no known exposure or signs or symptoms of current or past maltreatment.

Data Extraction and Synthesis  Two reviewers assessed titles/abstracts, full-text articles, and study quality, and extracted data; when at least 3 similar studies were available, meta-analyses were conducted.

Main Outcomes and Measures  Directly measured reports of child abuse or neglect (reports to Child Protective Services or removal of the child from the home); proxy measures of abuse or neglect (injury, visits to the emergency department, hospitalization); behavioral, developmental, emotional, mental, or physical health and well-being; mortality; harms.

Results  Twenty-five trials (N = 14 355 participants) were included; 23 included home visits. Evidence from 11 studies (5311 participants) indicated no differences in likelihood of reports to Child Protective Services within 1 year of intervention completion (pooled odds ratio, 1.03 [95% CI, 0.84-1.27]). Five studies (3336 participants) found no differences in removal of the child from the home within 1 to 3 years of follow-up (pooled risk ratio, 1.06 [95% CI, 0.37-2.99]). The evidence suggested no benefit for emergency department visits in the short term (<2 years) and hospitalizations. The evidence was inconclusive for all other outcomes because of the limited number of trials on each outcome and imprecise results. Among 2 trials reporting harms, neither reported statistically significant differences. Contextual evidence indicated (1) widely varying practices when screening, identifying, and reporting child maltreatment to Child Protective Services, including variations by race or ethnicity; (2) widely varying accuracy of screening instruments; and (3) evidence that child maltreatment interventions may be associated with improvements in some social determinants of health.

Conclusion and Relevance  The evidence base on interventions feasible in or referable from primary care settings to prevent child maltreatment suggested no benefit or insufficient evidence for direct or proxy measures of child maltreatment. Little information was available about possible harms. Contextual evidence pointed to the potential for bias or inaccuracy in screening, identification, and reporting of child maltreatment but also highlighted the importance of addressing social determinants when intervening to prevent child maltreatment.

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