The role of the healthcare librarian is an ever-changing one due to rapid advances in information technology, the growth of evidence-based medicine (EBM) and the use of systematic reviews. Systematic reviews provide the evidence to underpin EBM and are becoming a vital part not only of the process of summarising existing research but also of the process of planning future research.
EBM is not restricted to randomised trials, but "involves tracking down the best external evidence with which to answer our clinical questions"(1). The assessment of physical abuse in children is limited by a paucity of scientific evidence. There is a clear need for evidence-based guidelines for clinical practice and a demand by clinicians and law enforcement agencies for the highest standard of evidence for the assessment and diagnosis of these cases. To meet this need, we conducted the first systematic review of physical aspects of child protection based on a recognised methodology for undertaking systematic reviews (2).
Our first review the Child Protection Bruises study addresses two key questions:
1) Can you age bruises in children?
2) Are there patterns of bruising which are diagnostic or suggestive of child abuse?
The results have been presented at Paediatric and Multiagency conferences and have been accepted for publication in Archives of Disease in Childhood.
The findings of this first review will underpin:
•A new training manual of child protection for doctors through the Royal College of Paediatrics and Child Health.
•Development of posters and leaflets in conjunction with the National Society for the Prevention of Cruelty to Children (NSPCC) for training non-paediatric medical staff, nurses, nursery nurses and social workers.
•Identification of new forensic methods of assessing bruises in children who may have been abused.
This is a collaborative project between Information Services and the Child Health Department at the University of Wales College of Medicine conducted by the Welsh Child Protection Systematic Review Group, supported by the NSPCC. It is the first in a serious of systematic reviews of physical child abuse. The results of this project is already bringing about change in working practices not only of paediatricians but also of other medical and non-medical staff across the United Kingdom. This is an example of where the role of the librarian is effective in supporting evidence-based medicine.
1. Sackett, D.L., Rosenberg, et al (1996). Evidence-based medicine: What it is and what it isn't. British Medical Journal. 321: 71-2
2. NHS Centre for Reviews and Dissemination. Undertaking systematic reviews of research on effectiveness. 2nd ed. York: University of York, 2001. (CRD report No 4.)
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