Three studies that reported both sensitivity and false-positive rates were included in the review (n=2,949). Major methodological flaws for all studies included a lack of independence and blinding between clinical assessment and reference standard, and use of a different reference standard in children referred and those not referred. Full details of quality assessment results were reported in the appendix.
Two studies reported that clinical screening assessment based on the initial history and examination by a triage nurse and/or A&E doctor had sensitivity of 36% to 67% and false positive rates of 1% to 41%. One study reported that clinical screening assessment based on a checklist and full undressed examination of the child had sensitivity of 89% and specificity of 1%.
For studies that reported only sensitivity of clinical assessment, sensitivity ranged from 60% to 100% (four studies).
For studies reported only the false-positive rates of clinical assessments, false-positive rates ranged from 3.2% to 8.8% (four studies) when applying a standard threshold for confirming abuse and from 21.1% to 67.5% (two studies) when applying a high threshold for confirming abuse.