Adverse childhood experiences (ACEs) are common and can impact health across the life course. Thus, it is essential for professionals in child- and family-serving roles, including pediatric and adult primary care clinicians, to understand the health implications of childhood adversity and trauma and respond appropriately. Screening for ACEs in health care settings has received attention as a potential approach to ACEs identification and response. Careful examination of the existing evidence on ACEs screening and consideration, from a clinical and ethical perspective, of the potential benefits, challenges, and harms is critical to ensuring evidence-informed practice. In this critical appraisal, we synthesize existing systematic and scoping reviews on ACEs screening, summarize recent studies on the ability of ACEs to predict health outcomes at the individual level, and provide a comprehensive overview of potential benefits, challenges, and harms of ACEs screening. We identify gaps in the existing evidence base and specify directions for future research. We also describe trauma-informed, relational care as an orientation and perspective that can help pediatric and primary care clinicians to sensitively assess for and respond to ACEs and other potentially traumatic experiences. Overall, we do not yet have sufficient evidence regarding the potential benefits, challenges, and harms of ACEs screening in health care and other settings. In the absence of this evidence, we cannot assume that screening will not cause harm and that potential benefits outweigh potential harms.

中文翻译：

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童年不良经历筛查：批判性评估。


童年不良经历 （ACE） 很常见，会影响整个生命历程的健康。因此，担任儿童和家庭服务角色的专业人员，包括儿科和成人初级保健临床医生，必须了解童年逆境和创伤对健康的影响并做出适当的反应。在医疗保健环境中筛查 ACE 作为识别和应对 ACE 的潜在方法而受到关注。仔细检查关于 ACEs 筛查的现有证据，并从临床和伦理角度考虑潜在的益处、挑战和危害，对于确保循证实践至关重要。在这项关键评估中，我们综合了现有的关于 ACEs 筛查的系统和范围综述，总结了关于 ACEs 在个体层面预测健康结果的能力的最新研究，并全面概述了 ACEs 筛查的潜在益处、挑战和危害。我们确定现有证据基础中的差距，并为未来的研究指明方向。我们还将创伤知情、关系护理描述为一种方向和观点，可以帮助儿科和初级保健临床医生敏感地评估和应对 ACE 和其他潜在的创伤经历。总体而言，我们还没有足够的证据证明在医疗保健和其他环境中筛查 ACEs 的潜在益处、挑战和危害。在没有这些证据的情况下，我们不能假设筛查不会造成伤害，并且潜在益处大于潜在危害。