Loder Randall T, Feinberg Judy R
James Whitcomb Riley Hospital for Children, Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
J Pediatr Orthop. 2007 Jun;27(4):421-6. doi: 10.1097/01.bpb.0000271328.79481.07.
The purpose of this study was to examine the demographic and injury characteristics of children hospitalized with nonaccidental trauma as a causative factor using a large national database. Of the nearly 2.5 million cases in the database, 1794 (0.1%) were identified through diagnostic coding of abuse. Both sexes were equally represented, and two thirds had Medicaid as their primary payer. About one half of the children were younger than 1 year, but all ages were represented. The most common orthopaedic injuries were fractures of the femur or humerus, and most of those fractures occurred in children younger than 2 years. The most common nonorthopaedic injuries were contusions and brain injuries, with or without skull fracture, and 62 (3.5%) of the abused children died; almost all deaths were associated with brain trauma. Nearly one half of the abused hospitalized children between the ages of 3 and 20 years had a concomitant psychiatric or neurological condition. These data provide the orthopaedic surgeon with additional information to assist in identification of potential cases of nonaccidental trauma. In addition to presence of long bone fractures in infants and toddlers, older children with concomitant psychiatric or neurological conditions presenting with nonaccidental injuries should be assessed for possible abuse.
本研究的目的是利用一个大型国家数据库，调查因非意外创伤作为致病因素而住院的儿童的人口统计学和损伤特征。在数据库中近250万个病例中，通过虐待诊断编码识别出1794例（0.1%）。男女比例均等，三分之二的儿童以医疗补助作为主要支付方。约一半儿童年龄小于1岁，但各年龄段均有。最常见的骨科损伤是股骨或肱骨骨折，且大多数骨折发生在2岁以下儿童。最常见的非骨科损伤是挫伤和脑损伤，伴或不伴颅骨骨折，62例（3.5%）受虐儿童死亡；几乎所有死亡都与脑外伤有关。在3至20岁住院受虐儿童中，近一半伴有精神或神经疾病。这些数据为骨科医生提供了更多信息，以协助识别潜在的非意外创伤病例。除婴幼儿长骨骨折外，伴有精神或神经疾病且有非意外损伤的大龄儿童也应评估是否可能存在虐待情况。
