Chang David C, Knight Vinita Misra, Ziegfeld Susan, Haider Adil, Paidas Charles
Johns Hopkins Bloomberg School of Public Health, USA.
J Pediatr Surg. 2005 Jan;40(1):114-9. doi: 10.1016/j.jpedsurg.2004.09.019.
BACKGROUND/PURPOSE: There is currently no evidence-based screening instrument to assist in the detection of physical child abuse patients. The screening index for physical child abuse (SIPCA) was previously developed as a potentially new tool for this need. It is a scale that assigns point values, on the basis of variable weights from logistic regression models, to age and patterns of injuries (including fracture of base or vault of skull, contusion of eye, rib fracture, intracranial bleeding, multiple burns), with higher scores indicating greater suspicion for abuse. The purpose of this study is to validate this new tool in another independent data set.
A cross-sectional hospital discharge database from 1961 hospitals in 17 states is used (n = 58558). Children aged 14 years or younger with International Classification of Diseases, Ninth Revision, Clinical Modification codes 800 to 959 are included for analysis. Child abuse cases are identified by E codes and certain International Classification of Diseases, Ninth Revision, Clinical Modification codes in the 995.5x range. Screening index for physical child abuse performance is evaluated by discrimination (receiver operating characteristic) and goodness of fit (pseudo r2).
A total of 447 abused patients (0.76%) was identified. The receiver operating characteristic of SIPCA in this data set is 0.89 as compared with 0.86 in the development data set. The pseudo r 2 of SIPCA in this data set is 0.26 as compared with 0.28 in the development data set. A SIPCA score of 3 has a sensitivity of 86.6% and a specificity of 80.5% for detecting physical abuse; raising the threshold to a score of 4 improves the specificity to 93.1% but at a loss of sensitivity to 71.8%.
The validity of the new SIPCA instrument is supported by its performance in an independently derived data set. A score of 3 on SIPCA represents a balanced trade off in the sensitivity and specificity of the instrument in detecting physical abuse and is an optimal threshold above which to begin considering abuse in differential diagnosis. Application of the instrument could assist clinicians in detecting physical child abuse cases among pediatric trauma patients.
背景/目的：目前尚无基于证据的筛查工具可协助检测受身体虐待的儿童患者。儿童身体虐待筛查指数（SIPCA）此前被开发出来，作为满足这一需求的潜在新工具。它是一种量表，根据逻辑回归模型的可变权重，为年龄和损伤模式（包括颅骨基底或穹窿骨折、眼部挫伤、肋骨骨折、颅内出血、多处烧伤）赋予分值，得分越高表明虐待嫌疑越大。本研究的目的是在另一个独立数据集中验证这一新工具。
使用来自17个州1961家医院的横断面医院出院数据库（n = 58558）。纳入年龄14岁及以下、国际疾病分类第九版临床修订本编码为800至959的儿童进行分析。通过E编码和国际疾病分类第九版临床修订本中995.5x范围内的某些编码来识别虐待儿童病例。通过鉴别力（受试者工作特征曲线）和拟合优度（伪r2）来评估儿童身体虐待筛查指数的表现。
共识别出447名受虐待患者（0.76%）。该数据集中SIPCA的受试者工作特征曲线为0.89，而在开发数据集中为0.86。该数据集中SIPCA的伪r2为0.26，而在开发数据集中为0.28。SIPCA评分为3时，检测身体虐待的灵敏度为86.6%，特异度为80.5%；将阈值提高到4分可将特异度提高到93.1%，但灵敏度降至71.8%。
新的SIPCA工具在独立得出的数据集中的表现支持了其有效性。SIPCA评分为3代表了该工具在检测身体虐待时灵敏度和特异度之间的平衡权衡，是在鉴别诊断中开始考虑虐待的最佳阈值。该工具的应用可协助临床医生在儿科创伤患者中检测受身体虐待的儿童病例。
