Bullock Daniel P, Koval Kenneth J, Moen Kathleen Y, Carney Brian T, Spratt Kevin F
Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
J Pediatr Orthop. 2009 Apr-May;29(3):231-7. doi: 10.1097/BPO.0b013e31819aad44.
Orthopaedic surgeons need to recognize features of child abuse. The purpose of this study was to identify common characteristics of child abuse and to delineate features of physical injury cases that would raise concern for child abuse.
A nationally representative sample of all pediatric inpatient discharges for calendar years 1997, 2000, and 2003 was queried for physical injury diagnoses. Cases were identified as those with a diagnosis of child abuse and controls were those without the diagnosis of child abuse. Incidence of coded child abuse and a comparison of rates across time, demographics, and injury pattern were determined. Cases were compared with controls, and relative risks for coded child abuse were computed using the generalized linear model specifying the Poisson distribution and a log link.
There were 665,195 physical injury cases identified. Of these, 11,554 (1.74%) had a diagnosis of child abuse. Fracture requiring orthopaedic management was present in 28% of the child abuse cases. The 3 strongest demographic predictors of coded child abuse were age younger than 1 year, age 1 to younger than 2 years, and Medicaid as primary payer with adjusted relative risks of 11.46, 3.07, and 1.99, respectively. Winter and weekday presentation were significantly higher for coded child abuse. Fractures with the greatest adjusted relative risks for coded child abuse were rib or sternum (5.34) and scapula (3.22). Pelvic fracture was the only fracture significant for lowered adjusted relative risk of coded child abuse.
This study shows that young age continues to be a strong predictor of child abuse in the setting of physical injury. Supporting features include Medicaid as primary payer and winter or weekday presentation. Orthopaedists should be particularly aware of child abuse as 28% of cases had a fracture requiring orthopaedic management.
Prognostic Study, Level III (case-control study).
骨科医生需要识别虐待儿童的特征。本研究的目的是确定虐待儿童的常见特征，并描述可能引起对虐待儿童担忧的身体伤害病例的特征。
对1997年、2000年和2003年所有儿科住院出院病例进行全国代表性抽样，查询身体伤害诊断情况。确诊为虐待儿童的病例为病例组，未确诊为虐待儿童的病例为对照组。确定编码虐待儿童的发病率，并比较不同时间、人口统计学特征和损伤模式的发生率。将病例组与对照组进行比较，并使用指定泊松分布和对数链接的广义线性模型计算编码虐待儿童的相对风险。
共识别出665195例身体伤害病例。其中，11554例（1.74%）被诊断为虐待儿童。28%的虐待儿童病例存在需要骨科治疗的骨折。编码虐待儿童的3个最强人口统计学预测因素是年龄小于1岁、1至小于2岁以及以医疗补助作为主要支付方，调整后的相对风险分别为11.46、3.07和1.99。编码虐待儿童在冬季和工作日就诊的比例显著更高。编码虐待儿童调整后相对风险最高的骨折部位是肋骨或胸骨（5.34）和肩胛骨（3.22）。骨盆骨折是唯一与编码虐待儿童调整后相对风险降低相关的骨折。
本研究表明，在身体伤害情况下，年龄小仍然是虐待儿童的有力预测因素。支持性特征包括以医疗补助作为主要支付方以及冬季或工作日就诊。骨科医生应特别警惕虐待儿童情况，因为28%的病例存在需要骨科治疗的骨折。
预后研究，III级（病例对照研究）。
