Hayek Shady N, Wibbenmeyer Lucy A, Kealey Lyn Dee H, Williams Ingrid M, Oral Resmiye, Onwuameze Obiora, Light Timothy D, Latenser Barbara A, Lewis Robert W, Kealey Gerald P
Division of Plastic and Reconstructive Surgery, American University of Beirut, Lebanon.
J Burn Care Res. 2009 Jul-Aug;30(4):587-92. doi: 10.1097/BCR.0b013e3181abfd30.
Abuse by burning is estimated to occur in 1 to 25% of children admitted with burn injuries annually. Hair and urine toxicology for illicit drug exposure may provide additional confirmatory evidence for abuse. To determine the impact of hair and urine toxicology on the identification of child abuse, we performed a retrospective chart review of all pediatric patients admitted to our burn unit. The medical records of 263 children aged 0 to 16 years of age who were admitted to our burn unit from January 2002 to December 2007 were reviewed. Sixty-five children had suspected abuse. Of those with suspected abuse, 33 were confirmed by the Department of Health and Human Services and comprised the study group. Each of the 33 cases was randomly matched to three pediatric (0-16 years of age) control patients (99). The average annual incidence of abuse in pediatric burn patients was 13.7+/-8.4% of total annual pediatric admissions (range, 0-25.6%). Age younger than 5 years, hot tap water cause, bilateral, and posterior location of injury were significantly associated with nonaccidental burn injury on multivariate analysis. Thirteen (39.4%) abused children had positive ancillary tests. These included four (16%) skeletal surveys positive for fractures and 10 (45%) hair samples positive for drugs of abuse (one patient had a fracture and a positive hair screen). In three (9.1%) patients who were not initially suspected of abuse but later confirmed, positive hair test for illicit drugs was the only indicator of abuse. Nonaccidental injury can be difficult to confirm. Although inconsistent injury history and burn injury pattern remain central to the diagnosis of abuse by burning, hair and urine toxicology offers a further means to facilitate confirmation of abuse.
据估计，每年因烧伤入院的儿童中，有1%至25%的烧伤是由虐待造成的。毛发和尿液的非法药物暴露毒理学检测可为虐待行为提供额外的确证证据。为了确定毛发和尿液毒理学检测对儿童虐待识别的影响，我们对所有入住我院烧伤科的儿科患者进行了回顾性病历审查。我们回顾了2002年1月至2007年12月期间入住我院烧伤科的263名0至16岁儿童的病历。其中65名儿童被怀疑遭受虐待。在这些疑似受虐儿童中，有33名经卫生与公众服务部确认，组成了研究组。33例中的每一例都随机匹配了三名儿科（0至16岁）对照患者（共99名）。儿科烧伤患者中虐待的年平均发生率为每年儿科入院总数的13.7±8.4%（范围为0至25.6%）。多因素分析显示，5岁以下、热水致伤、双侧以及损伤位于身体后部与非意外烧伤显著相关。13名（39.4%）受虐儿童的辅助检查呈阳性。其中包括4名（16%）骨骼检查发现骨折阳性，10名（45%）毛发样本药物滥用检测呈阳性（1名患者骨折且毛发筛查呈阳性）。在3名（9.1%）最初未被怀疑但后来被确认为受虐的患者中，非法药物毛发检测呈阳性是唯一的虐待指标。非意外伤害可能难以确诊。虽然不一致的受伤史和烧伤模式仍是烧伤虐待诊断的核心，但毛发和尿液毒理学检测为协助确认虐待提供了进一步的手段。
