Lane Wendy G, Rubin David M, Monteith Ragin, Christian Cindy W
Division of General Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, USA.
JAMA. 2002 Oct 2;288(13):1603-9. doi: 10.1001/jama.288.13.1603.
Child maltreatment is a significant problem within US society, and minority children have higher rates of substantiated maltreatment than do white children. However, it is unclear whether minority children are abused more frequently than whites or whether their cases are more likely to be reported.
To determine whether there are racial differences in the evaluation and Child Protective Services (CPS) reporting of young children hospitalized for fractures.
DESIGN, SETTING, AND PATIENTS: Retrospective chart review conducted at an urban US academic children's hospital among 388 children younger than 3 years hospitalized for treatment of an acute primary skull or long-bone fracture between 1994 and 2000. Children with perpetrator-admitted child abuse, metabolic bone disease, birth trauma, or injury caused by vehicular crash were excluded.
Ordering of skeletal surveys and filing reports of suspected abuse.
Reports of suspected abuse were filed for 22.5% of white and 52.9% of minority children (P<.001). Abusive injuries, as determined by expert review, were more common among minority children than among white children (27.6% vs 12.5%; P<.001). Minority children aged at least 12 months to 3 years (toddlers) were significantly more likely to have a skeletal survey performed compared with their white counterparts, even after controlling for insurance status, independent expert determination of likelihood of abuse, and appropriateness of performing a skeletal survey (adjusted odds ratio [OR], 8.75; 95% confidence interval [CI], 3.48-22.03; P<.001). This group of children was also more likely to be reported to CPS compared with white toddlers, even after controlling for insurance status and likelihood of abuse (adjusted OR, 4.32; 95% CI, 1.63-11.43; P =.003). By likelihood of abuse, differential ordering of skeletal surveys and reporting of suspected abuse were most pronounced for children at least 12 months old with accidental injuries; however, differences were also noted among toddlers with indeterminate injuries but not among infants or toddlers with abusive injuries. Minority children at least 12 months old with accidental injuries were more than 3 times more likely than their white counterparts to be reported for suspected abuse (for children with Medicaid or no insurance, relative risk [RR], 3.08; 95% CI, 1.37-4.80; for children with private insurance, RR, 3.74; 95% CI, 1.46-6.01).
While minority children had higher rates of abusive fractures in our sample, they were also more likely to be evaluated and reported for suspected abuse, even after controlling for the likelihood of abusive injury. This suggests that racial differences do exist in the evaluation and reporting of pediatric fractures for child abuse, particularly in toddlers with accidental injuries.
虐待儿童是美国社会的一个重大问题，少数族裔儿童遭受确凿虐待的比例高于白人儿童。然而，尚不清楚少数族裔儿童是否比白人更容易受到虐待，或者他们的案件是否更有可能被报告。
确定因骨折住院的幼儿在评估和儿童保护服务（CPS）报告方面是否存在种族差异。
设计、地点和患者：在美国一家城市学术儿童医院进行回顾性病历审查，研究对象为1994年至2000年间因急性原发性颅骨或长骨骨折住院治疗的388名3岁以下儿童。排除有施虐者承认的虐待儿童、代谢性骨病、出生创伤或车祸所致损伤的儿童。
骨骼检查的安排以及疑似虐待报告的提交。
22.5%的白人儿童和52.9%的少数族裔儿童有疑似虐待报告（P<0.001）。经专家审查确定，虐待性损伤在少数族裔儿童中比白人儿童中更常见（27.6%对12.5%；P<0.001）。至少12个月至3岁的少数族裔儿童（学步儿童）与白人儿童相比，即使在控制了保险状况、独立专家对虐待可能性的判定以及进行骨骼检查的适宜性之后，进行骨骼检查的可能性显著更高（调整优势比[OR]，8.75；95%置信区间[CI]，3.48 - 22.03；P<0.001）。与白人学步儿童相比，即使在控制了保险状况和虐待可能性之后，这组儿童被报告给CPS的可能性也更高（调整OR，4.32；95%CI，1.63 - 11.43；P = 0.003）。按虐待可能性来看，骨骼检查安排和疑似虐待报告的差异在至少12个月大且有意外伤害的儿童中最为明显；然而，在损伤情况不明的学步儿童中也存在差异，但在有虐待性损伤的婴儿或学步儿童中没有差异。至少12个月大且有意外伤害的少数族裔儿童因疑似虐待被报告的可能性是白人儿童的3倍多（对于有医疗补助或无保险的儿童，相对风险[RR]，3.08；95%CI，1.37 - 4.80；对于有私人保险的儿童，RR，3.74；95%CI，1.46 - 6.01）。
在我们的样本中，虽然少数族裔儿童虐待性骨折的发生率较高，但即使在控制了虐待性损伤的可能性之后，他们被评估和报告疑似虐待的可能性也更高。这表明在儿童虐待的儿科骨折评估和报告中确实存在种族差异，尤其是在有意外伤害的学步儿童中。
