Goldberg Amy P, Tobin Jane, Daigneau Janet, Griffith Robert T, Reinert Steven E, Jenny Carole
Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island 02906, USA.
Pediatrics. 2009 Aug;124(2):604-9. doi: 10.1542/peds.2008-2900. Epub 2009 Jul 20.
We obtained normative data on bruising in children with physical disability in functioning and evaluated factors associated with bruising in this population.
We studied children with physical and/or cognitive disabilities who attend a school that provides comprehensive services. Over a 15-month period, the children had skin examinations, including external inspection of the genitalia and anus. For each child, we gathered information on demographics, medications, growth measures, medical conditions, equipment used, and muscle tone. Functional independence in basic mobility, self-care, and social communication was assessed by using the Functional Independence Measure for Children (WeeFIM). Results were compared with a previously studied nondisabled or "typical" population of children.
Fifty children and adolescents 4 to 20 years of age had 2 skin examinations. There was no relationship between the number of bruises and the child's age, race, or BMI. Overall, our subjects were more likely to have at least 1 bruise noted than nondisabled children from a comparable study. There was no significant relationship between the number of bruises and functional mobility, self-care, cognition, or muscle tone. The bruising locations in our study group were different from those of nondisabled children. However, in both groups bruises were rarely found on the neck, ears, chin, anterior chest, or buttocks.
The children in our study were different from nondisabled children in the frequency and pattern of their bruising. Areas uncommonly bruised in typical children were also uncommonly bruised in the disabled children. Although increasing age and mobility clearly make a difference in the number of bruises a typically functioning child sustains, these factors are not relevant when evaluating bruises on a child with disabilities. Other factors such as muscle tone, cognition, and equipment should be considered when evaluating a child with significant disabilities who presents with bruises.
我们获取了身体残疾儿童瘀伤情况的规范数据，并评估了该人群中与瘀伤相关的因素。
我们对就读于一所提供综合服务学校的身体和/或认知残疾儿童进行了研究。在15个月的时间里，对这些儿童进行了皮肤检查，包括对生殖器和肛门的外部检查。对于每个儿童，我们收集了人口统计学、用药情况、生长指标、医疗状况、使用的设备以及肌张力等信息。使用儿童功能独立性测量量表（WeeFIM）评估基本移动、自我护理和社交沟通方面的功能独立性。将结果与之前研究的非残疾或“典型”儿童群体进行比较。
50名4至20岁的儿童和青少年接受了两次皮肤检查。瘀伤数量与儿童的年龄、种族或体重指数之间没有关系。总体而言，与一项类似研究中的非残疾儿童相比，我们的研究对象更有可能至少有一处瘀伤被记录到。瘀伤数量与功能移动、自我护理、认知或肌张力之间没有显著关系。我们研究组的瘀伤部位与非残疾儿童不同。然而，在两组中，颈部、耳朵、下巴、前胸或臀部很少发现瘀伤。
我们研究中的儿童在瘀伤的频率和模式上与非残疾儿童不同。典型儿童中很少出现瘀伤的部位在残疾儿童中也很少出现瘀伤。虽然年龄增长和活动能力的增强显然会使典型功能儿童的瘀伤数量有所不同，但在评估残疾儿童的瘀伤时，这些因素并不相关。在评估有瘀伤表现的重度残疾儿童时，应考虑其他因素，如肌张力、认知和设备等。
