Table 4

Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Strait RT et al, 1995, USA124 children under 36 months with humeral shaft fractures identified by retrospective chart review.Subdivided into age less than 15 months and those aged 15 to 36 months. Diagnosis of abuse, indeterminate, or not abuse made by consensus.Diagnostic retrospective test studyAbuse diagnosed—overall Supracondylar fractures Spiral/oblique fractures<15 months: 36%;15–36 months: 1% <15 months: 2/10 (20%) <15 months: 7/12 (58%)Small numbers Single hospital “Gold standard” of diagnosis of abuse inadequate - based on retrospective chart review, with no standard criteria for the definition of abuse “Abuse”/ “not abuse” not determined in 23 cases. If all these were “abuse”, figures change dramatically. In case of Salter Harris I and II and lateral condylar group only single fracture of each type, skewing the validity of the calculations
Shaw BA et al, 1997, USA34 unselected children (<3 years) with humeral shaft fracturesRetrospective diagnostic test studyTransverse ObliqueSpecificity 57% (57%) LR+ 0.39 (0.72) Spec 79% (71%) LR+ 0.78 (0.27)Retrospective Gold standard problem—diagnosis of abuse based on retrospective case note review and information from child protection services; no standard criteria for the definition of abuse
SpiralSpecificity 68% (76%) LR+ 2.07 (2.58)Small numbers Single hospital