Trowbridge Matthew J, Sege Robert D, Olson Lynn, O'Connor Karen, Flaherty Emalee, Spivak Howard
Pediatric and Adolescent Health Research Center, Floating Hospital for Children, Tufts-New England Medical Center, Boston, MA 02111, USA.
Pediatrics. 2005 Oct;116(4):996-1000. doi: 10.1542/peds.2005-0618.
Intentional injuries are significant causes of pediatric morbidity and mortality in the United States. A 1998 American Academy of Pediatrics (AAP) survey identified child abuse, domestic violence, and community violence as concerns for pediatricians, although the majority of pediatricians also reported feeling unprepared to manage these issues. A second AAP survey in 2003 analyzed trends in pediatrician experience and attitudes related to these issues.
Surveys were sent to national random samples of AAP members in 1998 (n = 1629) and 2003 (n = 1603); response rates were 62% and 53%, respectively. Surveys measured pediatrician experience in the past 12 months in managing injuries caused by child abuse, domestic violence, and community violence. Attitudes regarding available resources and adequacy of training about intentional injury management were also collected. Trends between surveys were analyzed using chi2 analysis.
The proportion of pediatricians who reported treatment of intentional injuries increased between surveys. The percentage of pediatricians who indicated that screening for domestic violence and community violence risk should be included in routine health visits increased from 66% to 72% and 71% to 77%, respectively. Confidence in ability to identify and manage injuries that were caused by domestic violence and community violence increased but remained low, whereas the proportion of pediatricians who expressed confidence in ability to identify child abuse decreased (65% vs 60%).
Despite overall improvement in acceptance of intentional injury prevention in routine care as well as confidence in intentional injury management, pediatrician confidence to identify and manage intentional injuries remains low.
在美国，故意伤害是儿童发病和死亡的重要原因。1998年美国儿科学会（AAP）的一项调查将虐待儿童、家庭暴力和社区暴力确定为儿科医生关注的问题，尽管大多数儿科医生也表示在处理这些问题时感到准备不足。2003年AAP的第二项调查分析了儿科医生在这些问题上的经验和态度趋势。
1998年（n = 1629）和2003年（n = 1603）向AAP成员的全国随机样本发送了调查问卷；回复率分别为62%和53%。调查衡量了儿科医生在过去12个月中处理虐待儿童、家庭暴力和社区暴力所致伤害的经验。还收集了有关可用资源的态度以及关于故意伤害管理培训的充分性。使用卡方分析来分析两次调查之间的趋势。
在两次调查之间，报告治疗故意伤害的儿科医生比例有所增加。表示常规健康检查中应包括家庭暴力和社区暴力风险筛查的儿科医生百分比分别从66%增加到72%以及从71%增加到77%。识别和处理家庭暴力和社区暴力所致伤害的能力信心有所增加，但仍然较低，而对识别虐待儿童能力表示有信心的儿科医生比例下降了（65%对60%）。
尽管在常规护理中对预防故意伤害的接受度以及对故意伤害管理的信心总体有所提高，但儿科医生识别和处理故意伤害的信心仍然较低。
