Hereditary spherocytosis; new guidelines
Hereditary spherocytosis; new guidelines
复制标题
DOI：
10.1136/adc.2003.034587
复制
发表时间：
2004-09-01
影响因子：
5.2
通讯作者：
Bolton-Maggs, PHB
中科院分区：
文献类型：
--
作者：
Bolton-Maggs, PHB
所有儿科医生、儿科放射科医生、儿科病理学家、法医病理学家和许多其他专家都必须处理涉嫌虐待儿童的案件，就家庭投诉的产生而言，这是一项高风险活动。许多投诉毫无根据，但在某些情况下，由于方法错误，投诉是合理的。本次审查提请人们注意在考虑虐待儿童时与报告撰写相关的可避免陷阱（见方框 1）。关于疑似虐待儿童案件中专家职责的现代指南部分源于 1990 年审理的一个护理程序案例。一名 3 个月大的婴儿因严重受伤入院，包括超过一岁的硬膜下出血、大脑损伤、多处肋骨骨折和多处四肢骨折。尽管有证据表明儿童遭受虐待，但许多来自不同学科的专家对伤害提出了各种不合理或极不可能的替代医学解释（包括异常脆弱的骨骼）。法官对法庭上提供的一些专家报告和证据提出了高度批评，并在其公布的判决中就专家的职责提出了明确的建议。 1 方框 2 总结了这一内容以及随后各当局对专家工作的建议2-12。此外，高等法院家庭司法官编写了一本有用的手册，为护理程序中专家职责的各个方面提供简单实用的指导。 13
All paediatricians, paediatric radi-ologists, paediatric pathologists, forensic pathologists, and many other specialists have to deal with cases of suspected child abuse, and in terms of the generation of complaints from families this is a high risk activity. Many complaints are devoid of merit, but in some cases a complaint is justified because of a faulty approach. This review draws attention to the avoidable pitfalls associated with report writing when child abuse is under consideration (see box 1).The modern guidance on the duties of experts in cases of suspected child abuse stems in part from a care proceedings case heard in 1990. A 3 month old baby was admitted to hospital with serious injuries comprising subdural haemorrhages of more than one age, damage to the brain, multiple rib fractures, and multiple limb fractures. Despite the evidence pointing to child abuse, a number of experts from various disciplines offered a variety of unjustified or highly improbable alternative medical explanations (including abnormally fragile bones) for the injuries. The judge was highly critical of some of the expert reports and evidence given in court, and in his published judgment he gave clear advice concerning the duties of an expert. 1 This and subsequent advice from various authorities on the work of an expert2–12 is summarised in box 2. In addition, a High Court judge of the Family Division has written a useful handbook providing simple and practical guidance on all aspects of the duties of experts in care proceedings. 13